Soh Pheh Huang 1, Fadhlina binti Abd Sama2
1International Medical University
2Hospital Tuanku Jaafar
H, a 33-year-old Malay male who was recently diagnosed with Type 2 Diabetes Mellitus (T2DM) was admitted to hospital for diabetic ketoacidosis (due to missed medications). He was referred to the dietitian for poor oral intake and blood glucose optimization. At assessment, his weight was 80kg, with a BMI of 27kg/m2. He had experienced 33% of unintended weight loss since 2 months ago. His blood glucose readings ranged between 10.3-16.5 mmol/L. His intake at ward is poor due to Oral Candidiasis, provided 113kcal (8% energy requirement), 3g of protein (5% protein requirement). At home, 78% of his calories came from sugar-sweetened beverages for the past 2 months due to pain upon chewing and swallowing. His diet is also low in fibre rich sources. He had inconsistent meal timings as he is on shift work. He has limited knowledge on his disease and has never seen dietitian before.
Inadequate oral intake related to decreased ability to consume sufficient energy (oral candidiasis) as evidenced by diet recall at ward providing 113kcal and 3g of protein
Food and nutrition related knowledge deficit related to no prior exposure to nutrition related education as evidenced by patient verbalizing that he did not know the dietary management of T2DM.
The goal was to optimize oral intake at ward. Prescription was 1500 kcal, 80g protein, 169g carbohydrate. Provided minced diabetic diet and 6 scoops Nutren Diabetik with 1 sachet Miralac in 200cc water, thrice a day (89% energy, 88% carbohydrate and 86% protein requirements).
Monitoring & Evaluation
H was further diagnosed with gouty arthritis and had changed to subcutaneous insulin. Blood glucose readings remained high (16-20.1mmol/L). His oral intake had improved as oral candidiasis gradually resolved. Nutren Diabetik was stopped and indented with low purine, high protein, diabetic diet. Educated on low purine and diabetic diet for home.