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A 60-Year-Old Client, Mr

question 75

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A 60-year-old client, Mr. Hummel, has had type 2 DM for several years. Because of a change in insurance coverage, Mr. Hummel changes doctors and at his first appointment, a comprehensive medical exam and dietary history are performed. At the next few appointments, the certified diabetes educator, a registered dietitian, takes a full dietary history. Mr. Hummel works part-time in a seasonal sporting goods store, having retired last year after 35 years working for a manufacturing plant as a supervisor. He is married to a nurse who works full-time. He does most of the cooking and grocery shopping. He and his wife go for walks on weekends, but he does not exercise otherwise, except for doing chores around the house and occasional yard work or gardening. He is 5'9" tall and weighs 196 lbs., though when his diabetes was initially diagnosed, he weighed more.
Mr. Hummel is interested in weight reduction, especially if it will help him manage his blood glucose, and provides the following 24-hour food recall that typifies how he usually eats:
Breakfast (eats after taking morning blood glucose) : Pancakes with diet syrup or a bowl of cereal (usually corn flakes, Chex, or instant oatmeal) with Sweet 'N' Low and nonfat milk. Drinks coffee throughout the day starting at breakfast with two nondairy coffee creamer packets per cup. May or may not have 4 oz. of 100% fruit juice depending on hunger.
Lunch (eats after taking afternoon blood glucose) : Sandwich (rye or wheat bread) , deck of cards-size portion of lunch meat (salami, ham, bologna, turkey, or chicken) with thinly spread mayonnaise; coffee with nondairy creamers. May or may not eat a can of soup (cream of tomato, cream of chicken, or Italian wedding soup) instead of a sandwich, with two slices of buttered rye or wheat bread.
Afternoon Snack: Canned fruit or occasionally a cookie, doughnut, a piece of pizza, or a treat, depending on availability, hunger, blood sugar, and situation. Drinks coffee with nondairy coffee creamer. Usually also has a glass of ice water before dinner.
Dinner (eats after taking evening blood glucose) : Roast beef, meat loaf, steak, or another red meat; occasionally eats poultry or fish-approximate amount 8 oz.; plain baked potato, au gratin potatoes, or boiled buttered potatoes; a salad with bottled salad dressing or a vegetable, such as canned green beans; and a slice of rye or wheat bread with butter. May use ketchup, steak sauce, salt, and pepper. Drinks water with dinner.
Evening Snack: Varies-may eat a few handfuls of a bagged snack food, such as Doritos; a bag of buttered microwave popcorn; or cookies.
Labs are as follows:
Fasting glucose: 140-150 mg/dL
Glucose one to two hours after mealtime: 200 mg/dL
Average bedtime glucose: 152 mg/dL
Glycosylated hemoglobin (hemoglobin A_1C ) : 7.5%

Mr. Hummel had been taking oral hypoglycemic agents for three months prior to this visit. Based on his _____ measurement, his glycemic control over this period needed improvement.

Definitions:

Time of Day

The specific time within a 24-hour period, often considered as a factor affecting human behavior and biological processes.

Sleep Deprivation

A condition resulting from a lack of adequate sleep, which can affect cognitive functions, mood, and overall health.

Catch Up

Refers to the process of trying to reach the same level or standard as someone or something else, often after a period of lagging behind.

Sleepiness Decreases

A reduction in the feeling of being tired or the need for sleep, often resulting from rest or specific interventions.