Question: The Client Is A 73-year-old Man Diagnosed One Year Ago With Type 2 Diabetes Mellitus. He Has A History Of Coronary Heart Disease S/p Angioplasty 5 Years Prior, Hypertension, Retinopathy, And Left Foot Neuropathy. He Makes Every Attempt To Follow A Healthy Diet, And Has Been Avoiding Table Sugar For The Past Year On His Physician’s Advice. He Comes …

NUTRITIONAL ASSESSMENT DATA 1. Anthropometric Measurements. Height: 6’2″ Weight 220 lbs He weighed 240 lbs 5 years ago, and lost 30 pounds after his angio- plasty by adopting a lower fat dict. He has since regained 10 pounds. 2. Biochemical Data. Electrolytes, BUN, and creatinine values were normal. Normal Range/Target Parameter Value (may vary by age, sex, and lab) Glucose (mid-morning 223 mg/dL <180 mg/dL after meals fingerstick) Hemoglobin AIC 7.8% <7% in diabetes Total cholesterol 160 mg/dL <200 mg/dL LDL cholesterol 97 mg/dL <100 mg/dL HDL cholesterol 55 mg/dL > 40 mg/dL men > 50 mg/dL women Triglycerides 87 mg/dL < 150 mg/dL Data from American Diabetes Association. Standards of Medical Care in Diabetes – 2010. Diabetes Care. 2010: 33(Suppl 1):5511-5561. 3. Nutrition-Focused Physical Findings. Blood pressure: 130/80 mm Hg. 4. Client History Family Hx Paternal history is positive for heart disease and type 2 diabetes. He lives with his wife who does most of the cooking and shopping. He does not smoke and drinks alcohol socially. He gets little physical activity. 5. Food/Nutrition-Related History. The following represents his usual intake. Meal Breakfast Lunch Description Cold cereal (raisin bran), 2 oz Nonfat milk, 1 cup Cranberry juice, 1 cup 2 slices rye toast with 2 tbs fruit spread Coffee with 2 tbs fat-free hazelnut creamer Turkey club sandwich: 3 oz turkey 1 tbs reduced fat mayonaise lettuce and tomato sliced avocado 2 slices turkey bacon 2 slices white bread, toasted Fresh fruit, 1 piece Tea with 1 tbs honey 2 fat-free fig cookies cup apple cider 6 oz fish or chicken, baked or broiled cup cooked white rice or potato 1 cup cooked vegetable (carrots or green beans) 1 oz roll with 1 tbs stanol-ester enriched margarine Green salad with 2 tbs olive oil and 1 tbs vinegar Plain seltzer water, 12 oz 6 oz nonfat vanilla yogurt 1 cup mived nuts Snack Dinner Evening snack Medications Lipitor, Prevacid, ACTOplus met, and Januvia. Supplements No vitamins or supplements