Accepted Answer

Hi XXXXXXXXXXXXX,

First, here are links to the site I found most helpful in looking for information (pretending I didn't know anything about the subject).

MyPyramid.gov this is my favorite site for helping people with nutritional problems
MyPyramid's page for entering your info
MyPyramid's page for 1600 cal diet
MyPyramid's info about physical acivity
MyPyramid's page about weight control

American Diabetes Association home page (another favorite, more than enough info about Diabetes)
ADA's Diabetes Food Pyramid
ADA's page on Fitness
ADA's page on types of exercise
ADA's Overcoming Barriers
ADA's Small steps for your Health
ADA's Weight Loss page

USDA's food and nutrition center's page on dietary reference intake

Life Clinic page on Glucose control and exercise


OK, the rest is from my own nursing references and experience
-------------------
PROBLEMS:

• Diabetes Mellitus: a chronic metabolic disorder that affects the body's ability to manufacture and/or utilize insulin, the hormone produced by the beta cells of the pancreas. There are two major types: Insulin dependent (IDDM, or type I), and Noninsulin-dependent (NIDDM, or type II)

1. Alteration in Nutrition (more than body requirements if person is overweight, or taking more food in than the body uses) (less than body requirements if the person is underweight, takes in less food than the body uses, or with uncontrolled blood sugar that the body cannot utilize because of diabetes)
2. Knowledge deficits (regarding dietary planning) (regarding medication management) (regarding glucose monitoring) (regarding appropriate exercise regimen)

• Basic problems would be:

1. Diabetes mellitus with uncontrolled blood sugars
2. BMI 29.5 (overweight, bordering on obesity)
   
3. Lack of exerise (sedentary lifestyle) complicating both of the above
4. No knowledge of appropriate nutritional requirements

since you are primarily concerned with the nutrition and exercise aspects, I'll just focus on that. Let's go with 55 year old female, 155 pounds with almost sedentary lifestyle. This is the information I put into the MyPyramid planner above.

GOALS:

1. Blood sugars maintained within normal ranges (or parameters set by physician)
   
2. Gradually reduce BMI to <25, and maintain
3. Gradually work up to 60 minutes of moderate physical activity 5 days/week
4. Develop and maintain an appropriate diet plan to meet above goals

ACTIONS TO BE TAKEN TO MEET EACH GOAL:
1) ---Routine follow-up with physician
---Maintain medication regimen as prescribed by physician
---Follow appropriate dietary plan in conjunction with medication regimen
---Monitor Blood Sugar levels as prescribed by physician (usually twice daily)
---Report blood sugar levels as needed to physician when out of range


SORRY, THIS SENT BEFORE I WAS READY, WILL CONTINUE AND SEND MORE

2) ---Maintain adequate control of blood sugars, as above
---Follow appropriate dietary regimen (1600 calories/day per guidelines from MyPyramid and the ADA)
---Establish an exercise program to gradually increase tolerance to 60 minutes of moderate activity at least 5 days each week
---Discuss exercise regimen with physician
---Exercise at the same time everyday, to maintain balance with diet, medications and blood sugars

3) ---(you can choose an exercise from the above links, and just put in a plan that shows gradual progression to the target)

4)---(here you can put in the basic plan from MyPyramid in the link above, with all the "nuances", like the types of vegetables that need to be eaten each week to make sure all required nutrients are included in the diet; also look at the page from the ADA, there are minor differences in the recommended diet, but not much)

ANTICIPATED SETBACKS AND APPROACHES TO OVERCOME:

1) Blood sugars out of range due to a) changes in diet; b) change in exercise regimen
c) illness, infections
Approach: ---stay in close contact with physician while establishing an appropriate diet
----gradually increasing level of activity may change blood sugar levels; again stay in contact with physician until regular exercise regimen is reached and maintained
----when blood sugar levels are out of range, do not engage in strenuous activity

2) See the link for ADA's overcoming barriers for setbacks and approaches here

3) as #2

4) Setbacks: ---giving in to cravings for "junk food" and sweets;
---change in dietary requirements, or intake when ill
---socialization with others and eating out may cause breaks in plan
Approaches: Establish a good knowledge base regarding exchange of foods in each group to enable satisfaction of cravings. When ill, monitor blood sugars more frequently and dietary intake. Make food choices within exchange groups that are softer, more easily eaten and digested when ill. A good knowledge of food choices and exchanges will enable the person to make good choices when eating out with others. Plan ahead to choose items closely related to usual dietary plan. Choose lowfat items and condiments, fresh vegetables and fruits; lean meat that is roasted, baked, broiled or boiled.

OUTCOMES BY WHICH TO MEASURE SUCCESS:

1) Blood sugars monitored twice per day and recorded; within normal ranges or paramenters established by physician; other lab work done by physician within normal limits (glycated hemoglobin or AC1 test)

2) BMI gradually lowers; maintenance of BMI below 25.

3) Gradually increases exercise regimen until able to tolerate 60 minutes of moderately vigorous activity at least 5 days per week.

4) Will verbalize, or be able to make a written dietary plan for 1600 calories per day, low fat, incorporating whole grains, and different vegetables as outlined in MyPyramid plan.

Evidence of plan's effectiveness:

The person would be knowledgeable about disease process, medication regimen, blood sugar monitoring, nutritional planning and exercising within physical limits.
The person would maintain blood sugar levels within normal parameters; gradually lose weight until target weight is reached and then maintain that weight.

Evaluation of potential health risks:

See this page from the Mayo Clinic on Complications.



Ok, there you go. Good luck. If you have any questions, need more information, or some of the links don't work, let me know.


Valarie39964.6324321759

Expert:	Valarie
Pos. Feedback:	99.5 %
Accepts:	570
Answered:	5/31/2009

Nurse (RN)

35+ yrs nursing experience; Dir of Nursing Skilled Nursing/Rehab; Elder Care Consultant