Question 1: What are the current thoughts regarding the etiology of type 1 diabetes mellitus (T1DM)? No one else in Rachel's family has diabetes-is this unusual? Are there any other findings in her family medical history that would be important to note?
Question 2: What are the standard diagnostic criteria for T1DM? Which are found in Rachel's medical record?
Question 3: Dr. Cho requested these labs be drawn: Islet cell autoantibodies screen; TSH; thyroglobulin antibodies; C-peptide; immunoglobulin A level; hemoglobin A; and anti-tissue transglutaminase antibodies. Described how each is related to the diagnosis of type 1 diabetes.1C
Question 4: Using the information from Rachel's medical record, identify the factors that would allow the physician to distinguish between T1DM and T2DM.
Question 5: Describe the metabolic events that led to Rachel's symptoms and subsequent admission to the ED (polyuria, polydipsia, polyphagia, fatigue, and weight loss), integrating the pathophysiology of T1DM into your discussion.
Question 6: Describe the metabolic events that result in the signs and symptoms associated with DKA. Was Rachel in this state when she was admitted? What precipitating factors may lead to DKA?
Question 7: Rachel will be started on a combination of Apidra prior to meals and snacks, with glargine given in the a.m. and p.m. Describe the onset, peak, and duration for each of these types of insulin. Her discharge dosages are as follows: 7 u glargine with Apidra prior to each meal or snack-1:15 insulin: carbohydrate ratio. Rachel's parents want to know why she cannot take oral medications for her diabetes like some of their friends do. What would you tell them?
Question 8: Rachel's physician explains to Rachel and her parents that Rachel's insulin dose may change due to something called a honeymoon phase. Explain what this is and how it might affect her insulin requirements.
Question 9: How does physical activity affect blood glucose levels? Rachel is a soccer player and usually plays daily. What recommendations will you make to Rachel to assist with managing her glucose during exercise and athletic events?
Question 10: At a follow-up visit, Rachel's blood glucose records indicate that her levels have been consistently high when she wakes in the morning before breakfast. Describe the dawn phenomenon. Is Rachel experiencing this? How might it be prevented?
Question 11: The MD ordered a consistent carbohydrate-controlled diet when Rachel begins to eat. Explain the rationale for monitoring carbohydrate in diabetes nutrition therapy.
Question 12: Outline the basic principles for Rachel's nutrition therapy to assist in control of her T1DM.
Question 13: Assess Rachel's ht/age; wt/age; ht/wt; and BMI. What is her desirable weight?
Question 14: Identify any abnormal laboratory values measured upon her admission. Explain how they may be related to her newly diagnosed T1DM.
Question 15: Determine Rachel's energy and protein requirements. Be sure to explain what standards you used to make this estimation.
Question 16: Prioritize two nutrition problems and complete the PES statement for each.
Question 17: Determine Rachel's initial nutrition prescription using her usual intake at home as a guideline, as well as your assessment of her energy requirements.
Question 18: What is an insulin: CHO ratio (ICR)? Rachel's physician ordered her ICR to start at 1:15. If her usual breakfast is 2 Pop-Tarts and 8 oz. skim milk, how much Apidra should she take to cover the carbohydrate in this meal?
Question 19: Dr. Cho set Rachel's fasting blood glucose goal at 90-180 mg/dL. If her total daily insulin dose is 33 u and her fasting a.m . blood glucose is 240 mg/dL, what would her correction dose
Question 20: Write an ADIME note for your initial nutrition assessment.