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Diabetes Management: Case Study of a 7-Year-Old Boy, Study Guides, Projects, Research of Nutrition and Aging

Bellarmine University (BU)Nutrition and Aging

A case study of a 7-year-old boy named Christopher, who has been diagnosed with Type 1 Diabetes Mellitus (T1DM). the boy's medical history, current symptoms, and diagnostic results. It also outlines the problems that need to be addressed, interventions, and meal planning for managing T1DM in children. The document also explains the concept of the honeymoon phase and provides advice for parents regarding their child's participation in sports.

Typology: Study Guides, Projects, Research

2019/2020

Uploaded on 09/12/2021

Bigdbo1220
Bigdbo1220 🇺🇸

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EXS 425 Diabetes Project
Name: Derrick D. Dennis
Christopher is a 7yo male. He was diagnosed w/strep throat 4 weeks ago. He is still very tired. He
comes home from school, naps, eats dinner and goes to bed. He seems to be eating all the time, but it
does not improve his energy level. A visit to his pediatrician indicates T1DM. He and his parents will
be worked-up for introduction to insulin administration and diet modification.
A. wt: 48 lbs. (approx. 40th %ile). He has lost 5 lbs. in the past month.
ht: 48 in. (approx. 50th%ile)
B. glucose is 327mg/dl. Electrolytes are mildly elevated. Rapid strep test was negative.
C. Appears pale, wrung out. Dark circles under eyes. Oral cavity appears dry. Skin is dry, intact
w/no abnormal bruising
D. Mom reports appetite is good and eats just about anything. (See 24hr. recall below)
E. Lives w/parents and older sibling
24 hr. Diet Recall (Use either the textbook or the Exchange list in Moodle to analyze recall.)
g CHO g pro g fat
Breakfast
1 glazed donut 15 3 0
1 cup orange juice 15 0 0
Lunch (school)
2 oz. hamburger (medium fat) 0 7 8
Hamburger bun
½ cup green beans 2.5 1 0
½ cup fruit cocktail 7.5 0 0
1 cup chocolate milk 12 8 8
Snack
1 oz. potato chips 15 3 0
Dinner
1 cup spaghetti 43 3 0
2-1oz. meatballs (medium fat) 0 7 8
1 cup 2% milk___ 12__________________8
8_____________________________________________________
Totals (grams) 122g 40g 32g
total Kcal = 194
Distribution of Calories -194kcal x50% CHO = 97 Cal CHO/4 per gram =24.3g CHO
194kcal x20% PRO = 39 Cal PRO/4 per gram = 9.8g PRO
194kcal x30% FAT = 58 Cal FAT/9 per gram = 6g FAT
Percentages CHO= 122g/194kcal = 63%
PRO= 40g/194kcal = 21%
FAT= 32g/194kcal = 16.5 %
100.5%
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EXS 425 Diabetes Project Name: Derrick D. Dennis Christopher is a 7yo male. He was diagnosed w/strep throat 4 weeks ago. He is still very tired. He comes home from school, naps, eats dinner and goes to bed. He seems to be eating all the time, but it does not improve his energy level. A visit to his pediatrician indicates T1DM. He and his parents will be worked-up for introduction to insulin administration and diet modification. A. wt: 48 lbs. (approx. 40th^ %ile). He has lost 5 lbs. in the past month. ht: 48 in. (approx. 50th%ile) B. glucose is 327mg/dl. Electrolytes are mildly elevated. Rapid strep test was negative. C. Appears pale, wrung out. Dark circles under eyes. Oral cavity appears dry. Skin is dry, intact w/no abnormal bruising D. Mom reports appetite is good and eats just about anything. (See 24hr. recall below) E. Lives w/parents and older sibling 24 hr. Diet Recall (Use either the textbook or the Exchange list in Moodle to analyze recall.) g CHO g pro g fat Breakfast 1 glazed donut 15 3 0 1 cup orange juice 15 0 0 Lunch (school) 2 oz. hamburger (medium fat) 0 7 8 Hamburger bun ½ cup green beans 2.5 1 0 ½ cup fruit cocktail 7.5 0 0 1 cup chocolate milk 12 8 8 Snack 1 oz. potato chips 15 3 0 Dinner 1 cup spaghetti 43 3 0 2-1oz. meatballs (medium fat) 0 7 8 1 cup 2% milk___ 12__________________ 8_____________________________________________________ Totals (grams) 122g 40g 32g total Kcal = 194 Distribution of Calories -194kcal x50% CHO = 97 Cal CHO/4 per gram = 24.3g CHO 194kcal x20% PRO = 39 Cal PRO/4 per gram = 9.8g PRO 194kcal x30% FAT = 58 Cal FAT/9 per gram = 6g FAT Percentages CHO= 122g/194kcal = 63% PRO= 40g/194kcal = 21% FAT= 32g/194kcal = 16.5 % 100.5%

Meal plan Contains 122g CHOx4 = 488cal 40g PROx4 = 44cal 32g FATx9 = 288cal 820 Cal Functional analysis I. Identify the problems that need to be addressed w/this patient. Lowering that Elevated glucose below 140mg/dl instead of 327mg/dl and Electrolytes, Eating normal meals and still not energy, Sleeping all the time, Dark rings around eyes, Dry skin (Patient is Dehydrated) Increase fluids which will address His early stages of Ketoacidosis. II. Interventions What are the goals in the management of T1DM? The goals for the management of type 1 diabetes in adolescents are to (i) prevent diabetic ketoacidosis; (ii) prevent severe hypoglycemia; (iii) maintain normal growth and development; and (iv) prevent long-term diabetic complications. To prevent diabetic ketoacidosis, patients must take their insulin appropriately.

  1. His initial insulin regimen consists of 2 insulin injections/day. He is taking a combination of short acting insulin (2 units) + intermediate acting insulin (2units) in the morning and evening. His parents should be advised that breakfast and dinner should be provided when post insulin injection? To eat 15-30 minutes after receiving his morning and evening injections.
  2. Based on his age his estimated calorie needs are 1700 calories/day. If 50% of his total calories should come from carbohydrate foods, he should consume how many grams of carbohydrate/day? 1700kcalx.50%= 850 kcal CHO/4 per gram = 213g CHO per day or 25% of his meals should be CHO.
  3. Distribute the calculated grams of carbohydrate between the carbohydrate containing food groups in the exchange diet. No. of servings grams of CHO Starch 9 135 Fruit 2 30
  1. Christopher’s best friend is playing soccer at the “Y”. Christopher wants to play as well. The practices are once/week at 5pm for one hour. There is a match on Saturday morning that typically lasts one hour. What is your advice to his parents? I would explain to them that diabetes doesn't have to get in the way of exercise and sports competition. Chris need to get a sports physical before he start playing a sport. All kids with diabetes, should talk with their doctor before starting any new exercise routine that will really step up your child's activity level. Your doctor will let you know about any changes in testing schedule, medication, or other things you might need to think about for exercise and sports. Chris needs 30-60 CHO per hour if he plays 60 mins. Monitor BS prior to exercise and may reduce insulin dose to reduce need for additional CHO. If he plays, will there need to be any adjustments in his meal plan? If so, what adjustments should be made? Kids with diabetes need to take control of their own health. ... Kids should feel free to stop playing a sport or exercising to attend to their diabetes needs, like eating a snack for low blood sugar symptoms or checking blood glucose levels. Exercise helps control weight, lowers blood pressure, reduces harmful LDL cholesterol and triglycerides, raises healthy HDL cholesterol, strengthens muscles and bones, and reduces anxiety. Exercise can help regulate blood sugar and increase the body's sensitivity to insulin.
  2. The school’s administrative assistant called Christopher’s mother as he is running a fever and she needs to come pick him up. Once home, he starts vomiting. Using Exhibit 18-1 Sick Day Guidelines on page 287 in the textbook develop a dinner meal using the CHO from his meal plan (question no. 6). Total grams of CHO at dinner 60g  food item g CHO Fruit 15 Ginger Ale 15 Juice Bar 15 Bread 15 III. Cognitive Restructure Which component(s) of management do you feel are most important to stress w/this family? At least one close relative or patient’s caretaker should be familiar with Christopher’s diabetic treatment plan.

IV. Self-monitoring What does this family need to track in order to successfully manage Christopher’s diabetes? Christopher’s diet, Blood glucose, meals, exercise and weight loss or gain should be tracked.