NUTR 407 Diabetes/TLC Meal Plan Project

Nutr 407
ODay
Part A: ADIME
Recorder: Jennifer Axford
Patient Summary: Martin Young is a 37-year-old male admitted with acute
hyperglycemia.
History: History of CVD with non-compliance
Nutrition Assessment
Diagnosis: Diabetes Mellitus
Age, gender: 37, M
Dietary intake: PO
Allergies: None reported
Dietary Habits: Skips Breakfast
Symptoms: Frequent urination/excessive thirst and hunger
Anthropometric measurements
o Ht/Wt: 165.6cm (55)/77.3kg (170#)
2
o BMI: 28.2 kg/m (Overweight)
o IBW: 62kg (136#)
o %IBW: 124% (Obese)
Energy, protein and fluid needs
o Total energy = 1,873 2,435kcal/day
o Protein = 67 84g/day
o Fluid = 1,873 2,435mL/day
Basis for estimations (Based on BW of 84kg)
o For energy, used Mifflin St. Jeor formula to determine
REE then multiplied by activity (1.3) and stress factor
(1.0)
o For protein, used non stressed state: 0.8 1.0 g/PRO/kg
o For fluid needs, used 1mL/kcal/d
Lab/tests can indicate high or low, normal or abnormal
o A1C: 11.9% (High)
o PG: 242 mg/dL (High)
o Glycosylated hemoglobin: 9.4% (High)

o Fasting Blood Glucose: 180 mg/dl (High)

o HDL: 28 (Low)
o LDL: 144 mg/dL
o Cholesterol: 265
o Triglyceride: 279 (High)
Nutrition Diagnosis
NI-5.8.2 Excessive carbohydrate intake RT poor diet, physical
inactivity AEB high glycosylated hemoglobin (9.4%) and FBG of
180 mg/dl, A1C 11.9%, PG 242 mg/dL, frequent urination and
excessive thirst and hunger
Nutrition Intervention
1. Meals and Snacks
a. Do not skip breakfast
b. Choose healthier snacks and meals based on guidelines
for diabetics
i. 15-20% protein, <30%fat, & ~50% CHO
ii. Eat lots of whole-grains, fruits and vegetables
iii. Eat less fat
iv. Often small eating
v. Limit alcohol
2. Education: Nutrition adherence, self-monitoring importance
and importance of exercise and low glycemic diet
3. Nutrition Care Coordination: Refer to exercise specialist and
diabetic educator
Goals
1. Normalize blood glucose
2. Begin TLC, diabetic appropriate diet, effective today (appendix a)
3. Develop regular physical activity within 1 week
4. Develop CHO counting skills within 1 week
5. Normalize Glycosylated hemoglobin within 3 months
Monitoring and Evaluation
Follow-up phone call within 1 week
Ask the patient to do 3-day food record and bring it to clinic to
ensure adherence to diabetic-appropriate diet on next visit
Reevaluate glycosylated hemoglobin in 3 months

Part B: Meal Plan

Meal Pattern and Exchanges Table

Name: Martin Young
Diet Rx:

Diabetic Diet
50% Kcals CHO=
20% Kcals Pro =
30% Kcals Fat =

Starches

B
2

Fruit

Milk

: 2000 kcals
1000 kcals
400 kcals
600 kcals

L
2
1

3.5

12

5.5

CHO (g) Pro(g)

15
3
15

0.5

Total
7
4

0.5

Meats/Substitutes

S
1

1
1

CHO Choices

D
2

1
1

Vegetables

Fats

250 gm CHO
100 gm Pro
66 gm Fat

3.5

Fat(g)
1

Kcals
567
240

437.5
154

438

90

14.5
234.5
Kcals 938

102
408

64.5
580.5

%Kcals 49%

21%

30%

1926.5
Total
Kcals

Day 1
Breakfast:
C Oatmeal
1 4 oz
Banana
8 oz glass skim
milk 1 tsp unsalted
butter
Snack:
Apple
C Smoky bean dip
1 C each baby carrots, celery, sugar snap peas
Lunch:
2 Slices whole grain bread
2 - 1 oz slices of provolone cheese
slice of tomato, onion, lettuce, cucumbers, roasted red bell
pepper 2 Tbs avocado butter
8 oz glass skim milk
Snack
Cup
edamame 6 oz
yogurt dip
Dinner:
Cup brown rice
large cob corn
4 oz Grilled
Salmon
Spinach Salad
3 C Baby Spinach
C sliced tomatoes
1 Tbs EVOO + 2 Tbs Balsamic vinegar
Snack:

2 C Roasted Vegetable and Lentil soup (see appendix

...

Day 2
Breakfast
1 serving sweet potato hash
smoky yogurt sauce
See appendix () for recipe
Apple
Snack
C grapes
1/4 C Chipotle bean dip
See appendix () for
recipe
1 C each baby carrots, celery, sugar snap peas
Lunch
2 oz oven roasted chicken
breast 2 C baby spinach
Apple
1 C roasted butternut
squash 8 oz glass milk
Snack
1 C cucumber chips
6 oz Smoky yogurt
sauce
2 oz baked tofu strips
Dinner
1 C Roasted Vegetable and lentil soup with 2 oz tofu
squares 1 Slice whole-wheat toast with 3 Tbs avocado
butter
3 C Spinach salad with C chopped
tomatoes 1 Tbs EVOO & 2 Tbs balsamic
4 oz Glass of milk
Cob Corn (kernels added to leftover
hash) 1 serving leftover hash

Part C: Purchase Summary

Ingredients
Meal
Plan
Spinach mix Quantity
240 grams
Bananas
1 at 4oz
Milk
3 cups
Chicken
2 oz breast
breast
meat
12 oz bag
Butternut
squash
Carrots
1 bunch
Oatmeal
8oz (bulk)
Apple
3 each
6 oz
Roma
Tomatoes
Cheese Slices 2 slices

Total cost

1 lb

Price
Per Unit
.99/lb
.69/lb
gallon
1.77/lb

12 oz bag

2.48/bag

$2.48

1 bunch
8 oz
15 oz (3)
2 each

0.77/bunch
.79/lb
.68/lb
1.29/lb

$0.77
$0.34
$0.64
$0.48

1 Package

$3.00

$0.51
$0.33
$0.20
$0.68
$1.29
$0.69
$0.25

Quantity
Purchased
8 oz
1 (4 oz)

$0.50
$0.17
$1.00
$1.77

Salmon

4 oz

4 oz

Sugar snap
peas
Onion
Garlic
Corn
Celery
Tofu
Avocado
Sweet Potato

2 cups

8 oz bag

2 packages
for 6.00
$4.99 per
pound
$2.48

12 oz
3 cloves
1 ear
6 stalks
14 oz
1 each
1 each

12 oz (2)
1 head
1 ear
1 bunch
14 oz
1 each
6 oz (1)

.68 per pound

3/1.00
.20/ear
.68/bunch
1.29 each
.69 each
.68 pound

Green
Lentils
Yogurt
Brown Rice
Black Beans
Wheat Bread
Cucumber
Red pepper
Total Food
Cost

.25/lb

.99 per pound $0.24

12 oz
1 cup
4 oz (bulk)
1 slice
1.5 cup
3 cup

32 oz
3.44 oz
4 oz
1 loaf
1 each
2 each

2.99 each
.99/lb
.99 per pound
$2.50
.68 each
2/ 1.00

$1.25
$2.48

$2.99
$0.21
$0.25
$2.50
$0.68
$1.00
$26.70

Part D: Nutrient Analysis Discussion

Macronutrients and Total Kcals
Calories
The patient meal plan prescribed to Mr. Young successfully analyzed
within the estimated range of his REE of 1,873 2,435kcal/day and
reasonably near the 2000 kcal per day prescription deemed appropriate by
analyzing patients anthropometric data, current medical conditions (CVD,
T2DM) and abnormal lab values. Total kcals for day one reached 2063
kcals and 1866 kcal for day two, for an average of 1964.5 kcals per day.
Carbohydrates
The USDA MyPlate and DRI recommendations specify that total kcals for
carbohydrates stay within 45-65% of daily kcals. The Rx diet plan
accomplished this with a value of 56% for both days worth of meals and
snacks by choosing whole grains, fruits and vegetables as carbohydrate
sources.
Protein
Protein for day one was calucated at 23% and 26% for day two, which is
well within MyPlate guidelines of limiting protein choices to 10-35% of
daily kcals, however slightly higher than the TLC recommendations of
20% of daily kcals.
Fat and Saturated Fat
Fat was calculated within range of the 50 75 g defined by the NIH for the
TLC diet at 56.3 g for day 1 and 61.4 g for day two. Likewise, saturated fat
was below the recommended maximum of 7% with 4.5% and 5.8% for
days 1 and 2, respectively. This was made possible in part by using only
monounsaturated fats when cooking, using only medium fat or skim dairy
and lean proteins.

Cholesterol and Sodium

Dietary cholesterol was remarkably low at 110.2 mg and 75.8 mg for days
one and two, undoubtably because animal producs were used sparingly
with only salmon and skinless chicken breast as animal choices for protein
and tofu as a meat substitute.
Sodium values remained below the TLC diet guidelines of 1500 mg for
both days at 1226.8 mg and 1095.0 mg for days one and two. No salt was
added to any recipe and no processed foods were used whatsoever. In
addition, the use of bread products was minimized to keep sodium low.
Micronutrients
All micronutrients, with the exception of vitamin E for both days of the
meal plan and vitamin D for day 2 of the meal plan DRIs were met.
However, vitamin E units were near DRI guidelines at 12 mcg for day one
and two and vitamin D recommendations can be met from five to fifteen
minutes of sun exposure to compensate for the lack on day 2.

Part E: Reflection
Initially I found the carbohydrate exchange plan frustrating and pointless,
however, once I began to understand the concept and how to look up food
items in the Krauses appendices, I began to hit a groove. To save time, I
transferred the exchange table to an excel worksheet and entered equations
into the cells to reflect all changes and adjustments. I could not have
imagined having to recalculate all values manually every time I made a
change. When talking to other students who had to calculate changes by
hand, I realized a lot of time had been wasted and I did not want to make
the same mistake.
Likewise, using nutrient analysis software can be just as frustrating,
especially those online databases that are not well developed. However, a
classmate suggested I use a specific online nutrient analysis website that is
much more user-friendly than Calorie-Count, SuperTracker and others.
Despite being easier to use, inserting ingredients into nutrient tracker
software is not practical for the average person, which is why I understand
the value in the carbohydrate exchange system.
While the concept of carb counting is a useful method for monitoring total
carbohydrate intake, I still feel it is much too complicated for the average
person. What I took away from using the exchange system is that
more emphasis should be placed on consuming vegetables, particularly nonstarchy vegetables. In fact, it was difficult to include vegetables in the meal
plan due to the fact that three cups of raw vegetables were required to count
as one carbohydrate source. Additionally, if this amount was less than 3
cups (or 1 cups cooked), it would not be counted at all on the exchange
list.
I, as a dietitian, would much rather recommend that my patients consume
as many fresh vegetables (especially green, leafy vegetables) as possible
while limiting starchy vegetables and grains to once or twice per day,
maximum. This would keep sodium levels low (bread is especially high in
sodium) while still regulating blood sugar levels and creating a sense of
satiety after meals.
Finally, as an idealist I was frustrated by the fact that milk was necessary to
meet carbohydrate, protein and fat needs. It is my personal opinion that dairy
(aka milk) should not be necessary to meet patient macronutrient needs.

Day 1 Nutrient Analysis

Nutrient

Intake from Food

Calories

2063 Kcal

Recommended DRI with

adjustments for TLC Diet
Plan
2000

Fat

56.3 g

50 to 75 grams

Saturated Fat

10.5 g

Less than 7%

Trans Fat

0.0 g

None

Cholesterol

110.2 mg

Less than 200 mg

Sodium

1226.8 mg

1500 mg

Carbohydrate

282.1 g

130 grams (45-65%)

Protein

119.0 g

46 grams (10-35%)

Fiber

47.8 g

22 grams

Sugar

91.6 g

Limit

Calcium

1707.4 mg

1200 mg

Vitamin C

248.9 mg

75mg

Iron

19.4 mg

8 mg

Potassium

6286.6 mg

4700 mg

Vitamin A

2911 mcg

700 mcg

Vitamin D

15.2 mcg

15 mcg

Thiamin

2.5 mg

1.1 mg

Folate

1059.2 mcg

400 mcg

Riboflavin

2.8 mg

1.1 mg

Vitamin E

12.0 mcg

15 mcg

Niacin

48.1 mg

14 mg

B12

6.9 mcg

2.4 mcg

B6

3.6 mcg

1.5 mcg

Day 2 Nutrient Analysis

Nutrient

Intake from Food

Calories

1866 Kcal

Recommended DRI with

adjustments for TLC Diet
Plan
2000

Fat

61.4 g

50 to 75 grams

Saturated Fat

12.0 g

Less than 7%

Trans Fat

0.0 g

None

Cholesterol

75.8 mg

Less than 200 mg

Sodium

1095 mg

1500 mg

Carbohydrate

261.4 g

130 grams (45-65%)

Protein

119.0 g

46 grams (10-35%)

Fiber

47.8 g

22 grams

Sugar

115.0 g

Limit

Calcium

2103.6 mg

1200 mg

Vitamin C

248.9 mg

75mg

Iron

21.9 mg

8 mg

Potassium

7142.3 mg

4700 mg

Vitamin A

5189.0 mcg

700 mcg

Vitamin D

4.7 mcg

15 mcg

Thiamin

1.9 mg

1.1 mg

Folate

1005.8 mcg

400 mcg

Riboflavin

2.9 mg

1.1 mg

Vitamin E

12.0 mcg

15 mcg

Niacin

48.1 mg

14 mg

B12

3.9 mcg

2.4 mcg

B6

3.1 mcg

1.5 mcg

Appendices

Vons: 2.99/32 oz
Rice: $0.99 package
Club Card
Promo
960128277

Celery: $0.68 bunch

Salmon: 4.99/lb Sprouts

Brown
Stater Bros.

Onions: $0.68/lb

Tofu: $1.29/14 oz

Roma Tomatoes: 1.29/lb

Recipe Name

smoky bean dip

Description
Cooking Time

1 hour

Preparation Time

1 hour

Number of Servings

Ingredients

0.25 cup(s) Beans, black, dry, raw

1 pepper(s) Pepper, hot chili, red or green, raw
2 clove(s) Garlic, raw
1 tbsp(s) Margarine, tub, w/ olive oil, Becel
2 tbsp(s) Onion, raw
1 tsp(s) Paprika

Instructions

1. soak beans overnight

2. boil beans until tender 1 hour
3. mash beans and add ingredients, plus oregano 1 tsp mix well

Nutrients per serving

Calories (kcal)

153.7

Fat (g)

6.2

Saturated Fat (g)

1.0

Trans Fat (g)

0.0

Cholesterol (mg)

0.0

Sodium (mg)

53.8

Potassium (mg)

489.7

Carbohydrate (g)

19.9

Fibre (g)

4.3

Sugar (g)

2.2

Protein (g)

6.2

Vitamin A (RAE)

113.9

Vitamin C (mg)

57.1

Calcium (mg)

43.6

Iron (mg)

1.8

Vitamin D (g)

0.9

Vitamin E (mg)
0.6
Thiamin (mg) Riboflavin (mg) Niacin (NE) Folate
0.3
(DFE) Vitamin B6 (mg)
Vitamin B12 (g)
0.1
2.1
116.1
0.2
0.0

Recipe Name

smoky hash

Description
Cooking Time

15 minutes

Preparation Time

15 minutes

Number of Servings

Ingredients

1 medium (12.7cm x 5.1cm dia) Sweet potato, baked, skin removed after
baking
2 oz Onion, raw
0.5 cup(s) Pepper, sweet, red, raw
0.5 medium Carrot, raw
2 tbsp(s) Vegetable oil, olive

Instructions

1. chop veggies into small diced pieces

2. saute in olive oil on low heat covered for 10 minutes
3. serve

Nutrients per serving

Calories (kcal)

200.9

Fat (g)

13.9

Saturated Fat (g)

1.9

Trans Fat (g)

0.0

Cholesterol (mg)

0.0

Sodium (mg)

33.9

Potassium (mg)

439.7

Carbohydrate (g)

18.2

Fibre (g)

3.3

Sugar (g)

7.2

Protein (g)

2.0

Vitamin A (RAE)

733.6

Vitamin C (mg)

61.7

Calcium (mg)

36.0

Iron (mg)

0.7

Vitamin D (g)

0.0

Vitamin E (mg)

3.2

Thiamin (mg)

0.1

Riboflavin (mg)

0.1

Niacin (NE)

1.9

Folate (DFE)

28.8

Vitamin B6 (mg)

0.3

Vitamin B12 (g)

0.0

Recipe Name

smoky yogurt sauce

Description
Cooking Time

0 minutes

Preparation Time

4 minutes

Number of Servings

Ingredients

6 oz Yogurt, plain, 1% to 2% M.F.

0.25 tsp(s) Cumin seed
0.25 tsp(s) Paprika

Instructions

1. mix all ingredients and enjoy

2.
3.

Nutrients per serving

Calories (kcal)
Fat (g)

110.7
2.8

Saturated Fat (g)

1.7

Trans Fat (g)

0.0

Cholesterol (mg)

10.2

Sodium (mg)

120.1

Potassium (mg)

420.4

Carbohydrate (g)

12.5

Fibre (g)

0.3

Sugar (g)

12.0

Protein (g)

9.1

Vitamin A (RAE)

39.3

Vitamin C (mg)

1.8

Calcium (mg)

317.0

Iron (mg)

0.6

Vitamin D (g)

0.0

Vitamin E (mg)

0.3

Thiamin (mg)

0.1

Riboflavin (mg)

0.4

Niacin (NE)

1.2

Folate (DFE)

19.4

Vitamin B6 (mg)

0.1

Vitamin B12 (g)

1.0

Recipe Name

starch and vegetable soup

Description
Cooking Time

15 minutes

Preparation Time

15 minutes

Number of Servings

Ingredients

4 medium Carrot, raw

4 medium stalk(s) Celery, raw
5 cup(s) Water, municipal
0.5 cup(s) Lentils, dry raw

3 cup(s) Water, municipal

3 tbsp(s) Vegetable oil, olive

Instructions
toss veggies and roast in oven on 350 for 40 minutes
add vegetables, peppercorn and water to stock pot and simmer for 15 minutes
3.

Nutrients per serving

Calories (kcal)

103.2

Fat (g)

5.3

Saturated Fat (g)

0.7

Trans Fat (g)

0.0

Cholesterol (mg)

0.0

Sodium (mg)

45.0

Potassium (mg)

266.6

Carbohydrate (g)

10.7

Fibre (g)

2.3

Sugar (g)

2.1

Protein (g)

3.5

Vitamin A (RAE)

259.3

Vitamin C (mg)

2.9

Calcium (mg)

31.9

Iron (mg)

1.1

Vitamin D (g)

0.0

Vitamin E (mg)

1.1

Thiamin (mg)

0.1

Riboflavin (mg)

0.1

Niacin (NE)

1.3

Folate (DFE)

70.5

Vitamin B6 (mg)

0.1

Vitamin B12 (g)

0.0