Nur Atiqa Binti Ali1, Chloe Chong Zi Yi1, Nurulainin Sofia binti Hussin2
1 Division of Nutrition and Dietetics, School of Health Sciences, International Medical University Bukit Jalil, Kuala Lumpur.
2 Department of Dietetics and Food Service, Hospital Tuanku Ja’afar, Negeri Sembilan.
Mr ABAG is a 50 years old Malay male who was admitted due to hypoglycemia on 16th April 2021. Dietitian visited on day 4 of admission. He is an active smoker, has underlying Type 2 Diabetes Mellitus and Dyslipidemia and non compliant to insulin injection. During the dietitian’s visit, he is on post op day 1 of wound debridement of right lower limb for ruptured abscess of right lower limb. The patient has normal weight at 61kg at 171cm with BMI 20.9kg/m² which is normal. Patient HbA1c is 12.1% on 18th of April which indicates on poor glucose control. Patient was not eating 3 days prior admission as verbalized by his wife kept NBM for procedure in the ward. Patient’s usual diet intake at home is about 500kcal with 25g of protein. Patient has poor oral intake and has tendency to skip meals and only eat 2 meals a day. Patient and his wife has the knowledge on insulin injection timing and did not take insulin when he’s not eating. Patient’s SGA score is B which is mild moderately malnourished and mentioned frequently experience hypoglycemia.
Inadequate protein energy intake related to food and nutrition related knowledge on consistent meal timing as evidenced by patient only have two main meals per day which is breakfast or brunch and an early dinner and mentioned frequently hypoglycemia.
The goal is to provide patient adequate energy and protein for recovery. Prescription was 1200 kcal which is about 70% from estimated energy intake. 1200kcal is taken as patient had been kept NBM and had no intake for 6 days. The protein prescribed was 51 g. For initial intervention, patient was indent with high protein diabetic diet in ward. 70% of energy was provided from oral nutrition supplement (ONS) of Glucerna RTD and feeding as given as 1 can of Glucerna RTD, 4 times per day provide 1000kcal which is 83% of energy requirement and 40g of protein which is 78% of protein requirement.
Monitoring & Evaluation
Patient was planned for re-education for dietary management of Type 2 Diabetes Mellitus after meeting requirement of 70% from ONS and 30% from diabetic diet high protein diet but he was discharged on the next day.