Alina Ita Azhar1, Norazizah binti Mahidin2, Sarah Khalilah Binti Kasa2, Nurulainin Sofia Binti Hussin2
1Division of Nutrition and Dietetics, School of Health Sciences, International Medical University Bukit Jalil, Kuala Lumpur
2Department of Dietetics and Food Service, Hospital Tuanku Ja’afar, Negeri Sembilan
Mr C, a 64-year-old Chinese male is admitted for stroke on 15th March resulting in right hemiparesis. Dietitian visited 10 days post-stroke. He has poorly controlled diabetes on insulin treatment, hypertension, CKD stage 3a, and gout. The patient is obese (BMI 26.1 kg/m2) but experiencing weight loss since admission due to decreased oral intake caused by poor appetite and decreased self-feeding ability from the stroke recovery process. He has an eGFR of 44 and persistently elevated blood glucose, ranging from 13.3 mmol/L to 29.6 mmol/L. He is receiving intermediate-acting insulin 26 units ON and short-acting insulin 22 units TDS. Ward intake is 1000 kcal/day with 120 g carbohydrate (CHO). The inadequacy in dietary CHO intake might increase endogenous secretion of glucose which will complicate the glycaemic control.
Inadequate CHO intake RT loss of appetite decreasing overall food intake AEB consumption of 120 g CHO/day compared to the minimum requirement of 130 g/day as shown by ward diet recall.
The primary goal is to provide adequate and consistent CHO meal plans (including a CHO-controlled diet and diabetes-specific ONS) to optimise glycaemic control along with insulin regime. The patient’s prescription is 1700 kcal/day with 212 g CHO (50% TEI).
Monitoring & Evaluation
The patient was reviewed multiple times and prescription and interventions were revised based on the patient's intake and medical condition progression. Blood glucose improved, between 5.3 mmol/L to 12.0 mmol/L. Total energy intake, CHO amount and consistency, and compliance towards ONS were monitored while reinforcement education and counselling were incorporated when necessary.