C.D., a 58 year old female with type 2 DM, is admitted to the hospital for a laparoscopy. While she is there, the physician asks you to see her because her diabetes is not well controlled.

You go to see her and she tells you that she has had borderline diabetes for 4 years and has had a diet instruction before. She states that she has a sweet tooth and cannot give up sweets. Her weight is stable, and she does not exercise. She has been trying to lose weight.

A diet history indicates that she skips breakfast. For lunch, she eats a bologna and cheese sandwich with mustard and pickles on white bread, an apple, tea with 1 tsp. sugar, and 3-4 cookies. Then some crackers and cheese or a donut for a midday snack, and an evening meal consisting of a basic meat entree, a salad with regular salad dressing, a starchy vegetable, a non-starchy vegetable, and black coffee. She also eats cake and/or ice cream as a nighttime snack. She takes a multivitamin/mineral supplement. She has no known food allergies.

Medical history: Previously on oral hypoglycemic medication

Family history: Father had NIDDM and died of myocardial infarction at age 61. Mother died in a bungee jump fall at age 78. Current medications: Tylenol for knee pain. She is 62 inches tall and weighs 160 pounds with a medium frame.

Labs are as follows:

Lab	Value	Normal
Fasting glucose	148 - 290 throughout hospital stay	65-115
HbA1c	18%	4-8%
Albumin	4.0	3.5-5.5
T. Chol	235	<200
HDL-chol	23	>35

Case Questions

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