2018

Follow the Diet: Type II Diabetic

Naomi Solomon
FSN 429: Clinical Nutrition I
12/03/2018
FSN 429 Follow the Diet Naomi Solomon

Patient Profile:
23 YOF with BMI of 27.4 kg/m2 (68 kg) diagnosed with DMII 10 years ago and recently developed
neuropathy. MD instructed patient to consume 25-30 kcal/kg, no more than 1.0 g/kg for protein
(>10% kcal), and distribute carbohydrate servings evenly throughout the day, using CHO counting.
1. Nutrient Recommendations and Meal Pattern
a. Daily micronutrient requirements will follow the RDA for adults, as seen on the ESHA
Reports (see #3: Diet Analysis). Macronutrient specifications include 25-30 kcal/kg,
0.8-1.0 g protein per kg (>10% kcal), and even CHO distribution daily. Daily
macronutrient requirements will include:
i. 25 kcal/kg x 68 kg = 1700 kcal/day
ii. .55 (% kcal) x 1700 kcal = 935 kcal / 4 kcal/g CHO = 234 g CHO/day (55% kcal)
1. 234 g CHO / 15 g CHO per CHO serving = 15.6 (round down) = 15
exchanges
iii. 1.0 g/kg x 68 kg = 68 g protein/day (14.3% kcal)
1. Protein given = 3 NFM x 8 g pro/serving + 8 x 2 g pro/serving = 40 g
pro given
2. 68 g – 40 g = 28 g pro
3. 28 g pro / 7 g pro per pro serving = 4 exchanges
iv. 1.00 – .55 – .143 = .307 x 1700 kcal = 521.9 kcal / 9 kcal/g fat = 58 g fat/day
(30.7% kcal)
1. 58 g fat / 5 g fat per fat serving = 11.6 (round down) = 11 exchanges
b. Prospective Meal Pattern & Meal Plan

Meal Pattern
Total B L D AM snack PM snack HS snack
servings
CHO 15 4 5 3 1 1 1
NFM 3 1 1 1
Fruit 4 1 1 1 1
Starch 8 2 3 2 1
Pro (very 2 LP, 2 1 MFP 1 MFP 2 LP
lean) MFP
Fat 8 2 1 2 2 2
 FSN 429 Follow the Diet Naomi Solomon

1-Day Meal Plan

Food Exchange Kcal Pro Protein CHO CHO Fat Fat (g)
exchange (g) exchange (g) exchange
Breakfast:
2/3 c NF Greek 1 NFM 90 1.1 8 1 15 0 0
yogurt
¾ c blueberries 1 fruit 60 0 0 1 15 0 0
2 ww toast 2 starch 160 .6 4 2 30 0 0
1 egg 1 MFP 75 1 7 0 0 1 5
1 tsp canola & EVOO 1 fat 45 0 0 0 0 1 5
blend
2 Tbsp avocado 1 fat 45 0 0 0 0 1 5
½ c cooked spinach Free
Subtotal 475 2.7 19 4 60 3 15
AM snack:
1 small apple 1 fruit 60 0 0 1 15 0 0
1 Tbsp peanut 2 fat 90 0 0 0 0 2 10
butter
Subtotal 150 0 0 1 15 2 10
Lunch:
1 c chocolate NFM 1 NFM 90 1.1 8 1 15 0 0
1 fruit 60 0 0 1 15 0 0
1 c ww spaghetti 3 starch 240 .9 6 3 45 0 0
1 c cooked tomatoes Free
& spinach (2:1)
1 tsp canola & EVOO 1 fat 45 0 0 0 0 1 5
oil blend
Subtotal 435 2 14 5 75 1 5
PM snack:
1 small banana 1 fruit 60 0 0 1 15 0 0
1 Tbsp peanut 2 fat 90 0 0 0 0 2 10
butter
Subtotal 150 0 0 1 15 2 10
Dinner:
2/3 c brown rice 2 starch 160 .6 4 2 30 0 0
1 c cooked spinach Free
& mushrooms
(1:1)
1 tsp canola & EVOO 1 fat 45 0 0 0 0 1 5
blend
½ c tofu 1 MFP 75 1 7 0 0 1 5
2 tsp soy sauce Free
2/3 c NF Greek 1 NFM 90 1.1 8 1 15 0 0
yogurt
Subtotal 370 2.7 19 3 45 2 10
 FSN 429 Follow the Diet Naomi Solomon

HS snack:
1 c edamame, 2 LP 70 2 14 0 0 1.2 6
shelled 1 starch 80 .3 2 1 15 0 0
Subtotal 150 2.3 16 1 15 1.2 6
TOTAL 1730 9.7 68 15 225 11.2 56

2. Food Record (following the meal plan) – completed on 11/28/18

Food Exchange Kcal Pro Pro g CHO CHO g Fat Fat g

exchange exchange exchange
Breakfast: 6:45am
1 egg 1 MFP 75 1 7 0 0 1 5

1 ww toast 1 starch 80 .3 2 1 15 0 0

1 tsp canola & 1 fat 45 0 0 0 0 1 5

EVOO blend

1 oz avocado 1 fat 45 0 0 0 0 1 5

½ c cooked spinach Free

¾ c blueberries 1 fruit 60 0 0 1 15 0 0

2/3 c NF vanilla 1 NFM 90 1.1 8 1 15 0 0

Greek yogurt ½ fruit 30 0 0 .5 7.5 0 0

Subtotal 425 2.4 17 3.5 49.5 3 15

Snack: 10:30am
1 small apple 1 fruit 60 0 0 1 15 0 0

1 Tbsp peanut 2 fat 90 0 0 0 0 2 10

butter

Subtotal 150 0 0 1 15 2 10
Lunch: 1:00 pm
1 c ww spaghetti 3 starch 240 0.9 6 3 45 0 0

2/3 c cooked Free

tomatoes +
1/3 c cooked
spinach
1 tsp canola & 1 fat 45 0 0 0 0 1 5
EVOO blend
 FSN 429 Follow the Diet Naomi Solomon

1 ww toast 1 starch 80 .3 2 1 15 0 0

1 c 1% chocolate 1 1%M 100 1.1 8 1 15 .6 3

milk 1 fruit 60 0 0 1 15 0 0

Subtotal 525 2.3 16 6 87 1.6 8

Afternoon snack:
4:00 pm
1 small banana 1 fruit 60 0 0 1 15 0 0

1 Tbsp peanut 2 fat 90 0 0 0 0 2 10

butter

Subtotal 150 0 0 1 15 2 10
Dinner: 7:30pm
2/3 c long grain 2 starch 160 .6 4 2 30 0 0
brown rice

4 oz firm tofu 1 MFP 75 1 7 0 0 1 5

2 tsp canola & 2 fat 90 0 0 0 0 2 10

EVOO blend

½ c cooked Free
mushrooms
½ c cooked spinach
2 tsp soy sauce Free
2/3 c NF vanilla 1 NFM 90 1.1 8 1 15 0 0
Greek yogurt ½ fruit 30 0 0 ½ 7.5 0 0

Subtotal 445 2.7 19 3.5 49.5 3 15

Hs snack: 10 pm
1 c edamame, 2 LP 90 2 14 0 0 1.2 6
shelled 1 starch 80 .3 2 1 15 0 0

Subtotal 170 2.3 16 1 15 1.2 6

TOTAL 1865 9.7 68 16 231 12.8 64

Notes:
Breakfast: I substituted NF vanilla Greek yogurt (provided 1 NFM and 0.5 fruit exchanges) for NF
plain Greek yogurt. I took out 1 ww toast and saved it for lunch (photo in Photo Journal shows 2 ww
toasts, but only 1 toast was eaten).
Lunch: I included the 1 ww toast saved from breakfast. I replaced nonfat chocolate milk with low-fat
chocolate milk.
 FSN 429 Follow the Diet Naomi Solomon

4. Reflection & Photo Journal

Breakfast: AM snack:
• NF vanilla
Greek yogurt
• Blueberries
• WW toast
• Fried egg &
sautéed
spinach (w/
canola &
EVOO blend)
• Avocado

• Small apple
***One of the ww toast above • Peanut butter
was not consumed***
Lunch: PM snack:
• LF chocolate
milk
• WW toast,
• WW spaghetti
• Cooked
tomatoes &
spinach (w/
canola & EVOO
blend)

• Small banana
• Peanut butter

Dinner: HS snack:
• NF vanilla
Greek yogurt
• Brown rice
• Sautéed tofu
• Sautéed
spinach &
mushrooms
(w/ soy
sauce)
• Canola &
EVOO blend • Boiled shelled edamame
FSN 429 Follow the Diet Naomi Solomon

This diet was harder to plan than it was to follow, and even when I followed it, I struggled
following it thoroughly. But considering that I have a close family member who had recently been
diagnosed with type 2 diabetes, I was very interested to know how their diet might be. This, along
with the feasibility, reasonably priced grocery items, and the ADA Food Lists booklet, which I used
to make substitutions, helped me adhere to this diet as best as I could.
When I grocery shopped for my food, I quickly realized that nonfat chocolate milk was
difficult to find, and I included it in the meal plan because I have a sweet tooth for chocolate and
thought it would be convenient to include a serving of that (1 NFM + 1 fruit). I was only able to
purchase low-fat chocolate milk, which has 3 g of fat, so that increased my fat intake. I also failed to
compare sugar content for nonfat plain Greek yogurt and nonfat vanilla Greek yogurt and ended up
purchasing single-serve containers of the latter, which increased my CHO intake by 1 fruit exchange
total for both cups. For breakfast, I overestimated the amount of food I was able to eat, which
caused me to impulsively not eat one of the planned whole wheat toasts and saved it for lunch
instead (see Photo Journal). On top of that, another barrier was time, since I had class at 7:40 am,
and I ended up missing the bus due to the food preparation. Trying to follow the diet still, I was
computing in my head and measuring every ingredient, which I should have done the night before
to save time in the morning. I was not prepared for a big meal (at least for me) because I am not
used to eating such heavy meals before 9:00 am, and the meal I planned originally contained 475
kcals and multiple components. By saving 1 starch and deciding to include that in my lunch, I failed
to consider that my carbohydrate distribution became even more uneven. My meal pattern, which I
revised multiple times as I constructed my meal plan, was as follows: breakfast - 4 starch, am snack
-1 starch, lunch - 5 starch, pm snack - 1 starch, dinner – 3 starch, hs snack – 1 starch. Before I began
following the diet, I should have distributed the CHO more evenly to which lunch only contained 4
starches and dinner contained 4 starches. As the morning passed, since I had an early breakfast, by
10 am, I was feeling very hungry and the apple and peanut butter did not completely satisfy my
hunger. I should have eaten the piece of bread then so that I wasn’t starving by lunch time. By
adding the toast to lunch, that gave me a total of 6 starches for that meal and presumably caused
my blood glucose to be higher before dinner compared to the other meals.
Despite the challenges and adjustments I made while following the diet, I believe this diet is
sustainable. It doesn’t require any foods I’m unfamiliar with and isn’t expensive. I carefully chose
the components of my meals and snacks with regards to what I like and what I eat commonly, like
FSN 429 Follow the Diet Naomi Solomon

bananas, spinach, pasta, and rice, while sticking to the guidelines. Since my meals were more plant-
based, I took advantage of freely seasoning my food to make it more flavorful (i.e. I crumbled the
tofu and added Creole seasoning, turmeric, and other spices). Substitutions can be made easily as
long as the individual is willing to put a little more effort and time into planning what to eat and
realistically consider their lifestyle. As I mentioned, one of the barriers I faced was lack of time
because I had school to think about and my schedule to plan around. A type 2 diabetic patient may
also face this struggle, especially if they work and are sustaining a household. Depending on their
lifestyle, they could tailor the diet to their cooking skills and time for food preparation. For instance,
if a mother of two works a 9 to 5 job and must prepare lunch for her children, she could meal prep
the night before by packing vegetables and fruits in lunch boxes and make three sandwiches in
morning for her and her two children. Any leftovers from the previous dinner could be used for the
next day as well, either for meal time or snack times. The biggest challenge is, I believe, the
planning itself. This requires some practice and I strongly believe that if I were to plan another meal
pattern and meal plan, I would do better because now I know what my limitations are and,
surprisingly, this assignment gave me a better understanding of my own preferences and how much
I am able to eat. For instance, after lunch and dinner, I felt full and was not inclined to snack
afterwards, so a more even distribution of CHO exchanges (like add 1 starch to am and pm snacks)
could have made a difference in my appetite. For my carbohydrate intake, I often eat grains and
wheat products because they satisfy my cravings longer, so I should have considered that
information more closely. Because I hadn’t, I overestimated my ability to eat the amount of food I
planned for almost all the meals.
As a registered dietitian, nutrition knowledge is crucial to successfully adhering to a new
diet in addition to being motivated to change lifestyles. The latter is inherent, so as a dietitian, I can
only inspire and provide patients with the resources and tools to improve their attitudes and
perceptions about nutrition and increase their knowledge and skills in order to successfully adopt a
new diet. I would provide them with the ADA Food Lists booklet, consolidate the necessary
information regarding carb counting and carb distribution into a handout for them to take home
and use, and give them instructions on how to use these materials to plan and manage their new
diet at home, school, work, etc. This would be a major strategy in the intervention while applying
the Nutrition Care Process, and customizing the strategies to their lifestyle would also aid them in
adhering to this diet. I would refer them to the American Diabetes Association for online recipes
FSN 429 Follow the Diet Naomi Solomon

and encourage them to try new ways of cooking and foods they may not eat regularly (i.e. shelled
edamame, bought frozen at grocery stores). Lastly, I would encourage them to maintain a food
journal to keep track of their macronutrient consumption. As for micronutrients, I could give them
another handout that suggest foods that are rich in the main fat-soluble and water-soluble vitamins
and minerals, which they could use to plan their meals and snacks.
From this experience, I learned the difficulties of planning and adhering to a meal plan. It
was more difficult than I gathered because 1) I overestimated my ability to consume larger meals
than I’m used to at certain times of the day, 2) I underestimated the time it took to measure out
ingredients, and 3) I wasn’t used to snacking at all, especially snacking before bed time, so planning
my meal times and snacks with that closely in mind could have resulted in better food distribution
throughout the day in terms of satiety. More calorie consumption in the am and pm snack and less
in the morning and dinner may alleviate the issues I described, and this solution may also improve
the carb distribution throughout the day, depending on the types of exchanges I modify. Overall,
my experience turned out to be very educational and useful to my understanding of carb counting
and the challenges it comes with.