![\"Step](\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-1024x132.png\")
\r\n- \r\n \t
- Start out by greeting them and introducing yourself.<\/li>\r\n \t
- Describe the role of a registered dietitian relevant of their diabetes care.<\/li>\r\n \t
- Invite them into the conversation to build rapport and be an active participant in their health care.<\/li>\r\n \t
- Set the agenda for the appointment by asking about what brings them in and how you can help with the management of their diabetes.<\/li>\r\n<\/ol>\r\n[h5p id=\"1\"]\r\n
Gathering Data for an Assessment<\/h1>\r\nWhen gathering data for your assessment make sure to collect information on the patient\u2019s:\r\n
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- Clinical Data (both Medical history and Social history)<\/li>\r\n \t
- Anthropometric Data<\/li>\r\n \t
- Biochemical Data<\/li>\r\n \t
- Dietary Data<\/li>\r\n<\/ul>\r\n
\r\n Case Study: Meet Penelope<\/h2>\r\n<\/header>\r\n
\r\n\r\n[caption id=\"attachment_850\" align=\"alignnone\" width=\"1024\"]![\"Penelope,](\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/Diabetes_Actor-1024x576.png\")
Penelope Kelly, your client[\/caption]\r\n\r\nYou are playing the role of Katie, a dietitian in a diabetes program at a Community Health Centre outside of Toronto. You have received a referral from Dr. Darlington to see a client. Your client Penelope Kelly, is a 50 year old woman living in Barrie with her husband and 2 children. The reason for referral is related to her hypertension, recent diagnosis of Type 2 diabetes, and interest in losing weight. \u00a0She has coverage for her medication, and has used the food bank in the past because she couldn\u2019t afford food. She feels too tired to exercise and walks 15 minutes to the grocery store once a week. She wants to lose weight because she would like to have more energy and be healthier. The client is meeting with you this afternoon.\r\n\r\n<\/div>\r\n<\/div>\r\nClinical Data<\/h1>\r\n
Medical History<\/h2>\r\nWhen gathering clinical data, consider:\r\n
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- Diagnosis<\/strong>: Do they have prediabetes, type 2 diabetes, or gestational diabetes? Are they at risk of developing diabetes? How long have they had diabetes?<\/li>\r\n \t
- Past Medical History<\/strong>: Do they have other medical conditions (e.g. hypertension, dyslipidemia, cardiovascular disease, schizophrenia, depression, bipolar disorder, polycystic ovary syndrome, sleep apnea)?<\/li>\r\n \t
- Family History: <\/strong>Did members of their family have diabetes or other medical conditions?<\/li>\r\n \t
- Symptoms: <\/strong>Do they experience any complications of poor diabetes management (e.g. polydipsia, polyuria, neuropathy, nephropathy, sexual dysfunction, or problems with their vision, feet, or gums)?<\/li>\r\n \t
- Interdisciplinary team<\/strong>: Do<\/span> they regularly see an endocrinologist, chiropodist, dentist, optometrist, or nephrologist?<\/span><\/li>\r\n \t
- Medications: <\/strong>Are they on any oral anti-hyperglycemic agents, non-insulin injectables, and\/or insulin? Blood pressure or cholesterol medications? Are they taking any supplements?\r\n
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- Insulin<\/strong> is a very effective medication in managing all types of diabetes. To learn more, read\u00a0 Diabetes Canada's resources on insulin.\u00a0<\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n
Medications<\/strong><\/h3>\r\nWhen gathering medications as part of the nutrition assessment, refer to the Diabetes Medication Chart<\/a>. This chart summarizes the various types of oral hypoglycemic agents and any medications used for lowering blood pressure and cholesterol, and their side effects, nutrition interactions, and the parts of the body they act on to help control blood sugar.\r\n\r\n \r\n\r\n[h5p id=\"33\"]<\/span>\r\n
\r\n Penelope's Medical History<\/h3>\r\n<\/header>\r\n
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- Diagnosis<\/strong>: Type 2 diabetes (diagnosed 2 weeks ago)<\/li>\r\n<\/ul>\r\n
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- Past Medical History<\/strong>: Hypertension<\/li>\r\n<\/ul>\r\n
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- Medications<\/strong>: Dr. Darlington has discussed with Penelope that rather than start her on medications for diabetes or blood pressure, he would like to follow up with her in 2 months to see if her blood pressure and blood glucose can be controlled with changes in her diet and weight.\r\n
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- 500 mg calcium<\/li>\r\n \t
- 1000 [pb_glossary id=\"1636\"]IU[\/pb_glossary] vitamin D<\/li>\r\n \t
- 60 mg Diamicron (once daily with breakfast)<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
Social History<\/strong><\/h2>\r\nIt\u2019s also important to gather information on the client\u2019s social history, which will help you to tailor your nutrition plan later on. When gathering social history, consider:\r\n
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- Housing: <\/strong>What is their living situation? Do they live with others? Do they have a support system? Do they have access to a kitchen?<\/li>\r\n \t
- Income: <\/strong>Are they currently working? What is their main source of income?<\/li>\r\n \t
- Insurance: <\/strong>Do they have medical coverage?<\/li>\r\n \t
- Substance use: <\/strong>Smoking? Alcohol? Any other substances?<\/li>\r\n \t
- Food security: <\/strong>Has anyone in their household gone without food in the past month because they couldn't afford it? Do they ever have to use the food bank or skip meals because they do not have enough money for food?<\/li>\r\n \t
- Physical activity: <\/strong>Do they have any mobility issues (short or long-term)? Are there barriers preventing them from getting physically active (e.g. living in an unsafe area makes it difficult to get outside to exercise)?<\/li>\r\n<\/ul>\r\n
\r\n Penelope's Social History<\/h3>\r\n<\/header>\r\n
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- Housing<\/strong>:\u00a0 Lives in Barrie with her husband and 2 children.<\/li>\r\n \t
- Income: <\/strong>Not currently working (laid off), living off savings, has not qualified for social assistance.<\/li>\r\n \t
- Insurance: <\/strong>Has medical coverage.<\/li>\r\n \t
- Food security: <\/strong>Occasionally uses food bank, does not skip meals.<\/li>\r\n \t
- Physical activity<\/strong>: Sedentary most days due to fatigue, walks 15 minutes to the grocery store and back once a week.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
Anthropometric Data<\/h1>\r\nWhen gathering anthropometric data from the client, consider:\r\n
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- Weight: <\/strong>Current body weight in kilograms. If the client is open to having this taken, it can be valuable to know as part of their weight history.<\/li>\r\n \t
- Weight History: <\/strong>Do they have an interest in weight loss? Have they tried to lose weight before? Has their weight recently fluctuated? What was their highest and lowest adult body weight?<\/li>\r\n \t
- Waist Circumference: <\/strong>Current waist circumference in cm. If the client is open to having this taken, it can be a valuable screening measurement.<\/li>\r\n \t
- Height: <\/strong>Current height in centimetres.<\/li>\r\n \t
- BMI:\u00a0<\/strong>Body Mass Index.<\/li>\r\n<\/ul>\r\nIt\u2019s important to ask if the client is comfortable having these measurements taken as this may trigger stress for some clients. If the client states that weight loss is a goal for them, it can be helpful to know:\r\n
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- Why that goal is important for them.<\/li>\r\n \t
- If they have tried to lose weight before.<\/li>\r\n \t
- Any diets they have tried in the past.<\/li>\r\n \t
- How their weight has fluctuated over the years.<\/li>\r\n<\/ul>\r\n
\r\n Penelope's Anthropometric Data<\/h2>\r\n<\/header>\r\n
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- Weight: <\/strong>76.5 kg (Usual Body Weight for the past several years)<\/li>\r\n \t
- Height<\/strong> = 162.5 cm<\/li>\r\n \t
- BMI<\/strong> = 29 kg\/m2<\/sup><\/li>\r\n \t
- Weight History<\/strong>\r\n
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- Lowest adult body weight = 67 kg (15 years ago)<\/li>\r\n \t
- Has tried many diets in the past; some weight cycling<\/li>\r\n \t
- She would like to lose weight to feel healthier and have more energy<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
Biochemical Data<\/h1>\r\n
Diagnostic Criteria<\/h2>\r\nYou may need to interpret Oral Glucose Tolerance Test (OGTT), Fasting Blood Glucose (FBG), and Random Blood Glucose (RBG) values for a client to see if they are at risk of diabetes, have pre-diabetes, or are newly diagnosed with diabetes. The most common lab value you will use is Glycated Hemoglobin (HbA1C or A1C), as this can tell you how well their diabetes and blood sugars have been managed over the past 3 months.\r\n
- Height<\/strong> = 162.5 cm<\/li>\r\n \t
- Weight: <\/strong>76.5 kg (Usual Body Weight for the past several years)<\/li>\r\n \t
- Weight History: <\/strong>Do they have an interest in weight loss? Have they tried to lose weight before? Has their weight recently fluctuated? What was their highest and lowest adult body weight?<\/li>\r\n \t
- Income: <\/strong>Not currently working (laid off), living off savings, has not qualified for social assistance.<\/li>\r\n \t
- Income: <\/strong>Are they currently working? What is their main source of income?<\/li>\r\n \t
- Housing: <\/strong>What is their living situation? Do they live with others? Do they have a support system? Do they have access to a kitchen?<\/li>\r\n \t
- Medications<\/strong>: Dr. Darlington has discussed with Penelope that rather than start her on medications for diabetes or blood pressure, he would like to follow up with her in 2 months to see if her blood pressure and blood glucose can be controlled with changes in her diet and weight.\r\n
- Past Medical History<\/strong>: Hypertension<\/li>\r\n<\/ul>\r\n
- Diagnosis<\/strong>: Type 2 diabetes (diagnosed 2 weeks ago)<\/li>\r\n<\/ul>\r\n
- Past Medical History<\/strong>: Do they have other medical conditions (e.g. hypertension, dyslipidemia, cardiovascular disease, schizophrenia, depression, bipolar disorder, polycystic ovary syndrome, sleep apnea)?<\/li>\r\n \t
- Diagnosis<\/strong>: Do they have prediabetes, type 2 diabetes, or gestational diabetes? Are they at risk of developing diabetes? How long have they had diabetes?<\/li>\r\n \t