Siti Basyirah Ahmad Anuar1, Jazlina Syahrul2, Zuriati Ibrahim1
1Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
2Department of Dietetics, Hospital Pengajar Universiti Putra Malaysia (HPUPM), Universiti Putra Malaysia.
A 71-year-old, Malay female is a retired government staff currently staying with her daughter as her main caregiver. Patient has been diagnosed with diabetes mellitus for over 20 years and is currently on fixed insulin regime with underlying hypertension, hyperlipidemia, and primary open angle glaucoma with left-eye blindness. Patients' height is 152 cm and her current weight is 67 kg. Patient was urgently referred to dietitian due to her DXT reading at 3.0 accompanied with shivering and cold sweat and patient insisted to fast despite being high-risk. Patients SMBG showed frequent hyper- and hypoglycemia and patients’ food history showed that patient has inconsistent meal timing and missed insulin injection.
Inconsistent carbohydrate intake related to prior exposure to incorrect information/misconception about meal timing as evidenced by food history (inconsistent carbohydrate distribution 3/-/1+1/1/3), SMBG (pre-bed 12.0, pre-breakfast 3.0) and HbA1c 12.5%.
The objective of management is to ensure patient to have safe Ramadan fasting with prevention of hypo- and hyperglycemia and to improve her dietary intake especially her carbohydrate distribution. Patient was prescribed with energy of 1400 kcal/day with 12 exchanges of carbohydrate. Patient was also educated on carbohydrate distribution during Ramadhan and the importance of having adequate carbohydrate intake especially during sahur. Patient was also prescribed with diabetes-specific formula (DSF) to be used as complementary of her nutrition intake and better glycemic control.
Monitoring & Evaluation
After the third follow up, patients’ daughter claimed that patient has been regulating her mealtime based on the Ramadan nutrition plan provided to achieve daily requirement of carbohydrate per day. Patient also showed improvement in her blood glucose control ranging between 5.1-8.3 mmol/L throughout the day during the fasting period and reported no hypo- and hyperglycemia symptoms.