Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "

Case study ( 2960 views as of June 27, 2017 )

John is 55 years old and was recently diagnosed with Type 2 Diabetes. For several years his family physician has warned him that he was at high risk of developing Type 2 Diabetes due to a strong family history of Type 2 Diabetes, his age and obesity. John is 5 feet 9 inches and 220lbs, giving him a BMI of 32.7. His family physician has encouraged him to lose at least 5% of his weight (11 lbs) to reduce his risk of developing Type 2 Diabetes. Although John has made some attempts to lose weight, he has not been very motivated and has never lost more than 5 lbs before regaining the weight back.

Today John is in to see a registered dietitian to learn more about healthy eating to manage his blood glucose and to lose weight. His family physician has given him 3 months to try and manage his blood glucose before starting medications. He has been testing his blood glucose at home occasionally and is frustrated that his numbers are above target because he tells the dietitian that he doesn’t eat sweets.

After a review of John’s diet, the dietitian identifies a few areas that John can focus on to improve his blood glucose. Although John eats an overall balanced diet and limits his intake of sweets and treats, he does have large portions and often drinks fruit juices.

John does not do any regular physical activity at this point in time. He expresses more motivation now then ever before to lose weight as he is afraid of developing the complications of diabetes and wants to know what he should to do improve his blood glucose.

John could benefit from seeing an endocrinologist to discuss treatment options for diabetes management and complication prevention. He would also benefit from seeing a Certified Diabetes Educator (registered nurse and/or registered dietitian) to support him in managing his diabetes at home on his own. Continuing to follow-up with a registered dietitian would help him make necessary changes to his diet for better blood glucose control and weight loss. A personal trainer could help him start a regular exercise routine that would meet his needs. It may also be beneficial for John to see an ophthalmologist and dentist for baseline screenings, or to uncover any associated conditions like diabetic retinopathy and gum disease.

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Conversation based on: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "

Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "

  • A good friend of mine who is 60 was just diagnosed and it was a big shock to him.
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  • My dad has type 2 diabetes and his doctor recommended that he begin to wear the support socks. What is the difference between diabetic socks and the compression stockings ?
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  • John should also be taught the importance of foot care and educated on the warning signs of poor circulation and sores or ulcers on the feet. Along with regular exercise and diet and blood sugar control, John needs to practice good foot care. My father has had diabetes for 30 years and had to have all of his toes amputated in the past year due to circulation problems.
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    • Absolutely @K.Michael!! Diabetics can lose sensation in their feet as their circulation worsens, and they would be less likely to notice a cut on their foot. Left unnoticed or untreated, this cut can easily turn into an infected one, which can lead to serious issues. Foot care in diabetics should be a priority, and it's great that your aunt has someone coming in for home support to help her.
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    • My aunt has a number of health issues and has someone from CCAC come in on a monthly basis to help with her feet. Would this be something a diabetic could benefit from ?
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  • The recommendation that John see an ophthalmologist is such an important one. My father was experiencing on and off issues with his vision that he never associated with the fact that he was pre-diabetic. He now has permanent damage to his vision
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    • Thank you for your comment and sorry to hear that your father has some vision damage. The 2013 Clinical Practice Guidelines indicate that people with Type 2 Diabetes should have their eyes checked annually to assess for early signs of damage from Diabetes. This helps prevent issues from Diabetic Retinopathy and other associated eye disease.
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  • As has been said, getting the motivation to increase physical activity can be difficult. John might benefit from group exercise, where everyone present is in a similar situation. Encouragement and support from peers may be what he needs to stick to an exercise routine. In addition, taking part in activities that he genuinely enjoys will go a long way. Making exercise something to look forward to, instead of an obligation, will help boost John's motivation to be active. In terms of his diet, perhaps he could start to cut out the fruit juice by diluting his portions with water so that he gradually consumes less and less sugar.
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    • Or perhaps switching his juice to smoothies that will up his vitamin and vegetable intake
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  • Exercise doesn't have to mean being stuck in a gym. In addition to speaking to a personal trainer or dietitian he should look outside the box at activities like boxing, fencing, soccer or rugby.
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  • Increasing his water intake should naturally lower his fruit juice consumption. He should start with aiming to get in 2 liters of water daily. After drinking 2 liters, there isn't enough time in the day to drink anything else!
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    • This is a great suggestion. It will help quench your thirst without extra sugars and calories.
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    • This is very true. Herbal ice teas sweetened with agave or honey are also good substitutions if you can't go straight to just water. It's much better than drinking soda and other sugary drinks
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  • I think that John needs to make some changes using baby steps. We don't want to place radical changes on him swiftly, or he will not stick with his new regime again. Perhaps a good starting point would be to change a few eating habits (like adding more vegetables to meals) and walking for deliberate exercise a few times per week. When these changes become his new norm, more changes can slowly be introduced.
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    • Good point! Small changes that are realistic and achievable will set John up for success and he can build on these successful changes as time moves on. It is also important to think about some potential obstacles and have a plan to overcome them in order to stay on track with healthy changes.
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    • This is such a good point. When my father received his diabetes diagnosis he felt he was being told to change everything. As a result he rebelled and refused to change anything. Working the changes in, in baby steps, is a much easier way to ensure lasting change.
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  • The case study indicates that John has attempted to lose weight several times but always ends up gaining the weight back. It seems like this time he might have the drive required to make lasting changes to his eating
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    • I think John might benefit from consulting a Wellness Coach - someone who is qualified to help guide him through making these small changes in his lifestyle to improve his overall health. A wellness coach can help John channel his motivation into actually effecting some good changes, and break his efforts into chunks/goals so that he can work on gradually getting to his ultimate goals.
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    • What are some suggestions that John can be given to ensure he stays on track ? It is hard for an individual to come up with a plan and stick to it, however if it is something they find easy then it is more likely they will stick to the routine.
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  • Although historically we've used body mass index as part of the criteria to diagnose obesity, again a BMI over 30 as being diagnostic, in fact, BMI has been criticized as an imperfect measure. It doesn't account for muscle, so an individual with a large muscle mass will have a higher BMI, but actually not an increased risk.
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    • Waist circumference has been singled out as a predictor of risk for various health conditions, whether it's diabetes, high cholesterol, high blood pressure or heart disease. BMI is a simple calculation that most people can figure out at home, however more and more research seems to be emerging to support the measuring of waist circumference. I teach all my clients how to properly measure their waist circumference at home, as many people are measuring incorrectly.
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    • Excellent point. We need to include other measures such as waist circumference and activity level in our assessments to have a full picture of a patient's health status. BMI alone is not always enough.
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    • I agree. BMI alone doesn't give the full overall health picture.
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  • I think John should be referred to an exercise specialist to help him develop some strategies around adding physical activity to his lifestyle. A simple tool would be to give him a pedometer and have him log his current daily step count. This can be a basic starting point for John to try and move more throughout his day. Having the number at the end of the day is instantly gratifying when it shows an increase and he could use this as a motivator toward sticking with his healthy lifestyle changes.
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    • This is a great suggestion. Oftentimes exercise is one of the first suggestions when people are diagnosed with a medical condition but it can be difficult to find a starting point. An exercise specialist would be incredibly helpful
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    • This was suggested to a friend and a goal was set by her family doctor. She had to walk x steps the first week, then it increased by 10% the second week, another 10% the third week and now the 4th week her goal is another 10%. Her doctor has told her to maintain the 4th week goal moving forward and to increase the speed or amount of steps as she sees fit. She is excited by this and has been using the Fitbit to track this, along with her sleep, etc.
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  • It's very important to have a full health care team when dealing with a diabetes diagnosis. My father was recently diagnosed with diabetes. He was pre-diabetic for a number of years but didn't disclose that to his dentist or ophthalmologist. It turns out he was experiencing diabetic issues in those areas that could have been handled much better if everyone was aware of his condition.
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    • I didn't realize how many facets of our health that diabetes affects. It is very important to make sure that your whole health care team is involved.
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    • If you have any questions about obesity, the measurement or treatment of it, please do discuss it with your primary care practitioner.
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    • It is fat that carries with it an increased insulin resistance, makes it harder to metabolize sugar, makes it more likely you're going to get diabetes, high blood pressure, high cholesterol, heart disease, and increased risk of cancer. So how much fat you have is very, very critical.
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  • Regular visits to the dietitian can help John make the necessary changes to his diet that will help get his numbers on target.
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    • By setting up visits to a Dietitian and assisting with a food management program John will be able to get himself on track. John also needs to understand that diet and some exercise go hand in hand in losing weight and maintaining a healthy lifestyle.
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    • I strongly feel the consistent follow-up is crucial to helping John stick with his goals. He can use the dietitian to ask questions, share successes and challenges, and brainstorm in order to face perceived obstacles and tweak his plan to suit his needs.
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    • Thanks K. Michael. I agree that regular visits with the Dietitian are very helpful. The Dietitian can offer education, support and come up with strategies to overcome obstacles to eating healthy.
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