Patient
MH

Height: 6 ft 0 in

Weight: 385 lbs

BMI: 52.2

Registered Dietitian

Tegan Bissell, RD

Insurances: Aetna,Anthem,Blue Cross Blue Shield,Cigna,United Healthcare

Diagnosis and Treatment Plan

Diagnosis:

Client presents with food and nutrition knowledge deficit related to diet for diabetes as evidenced by A1c of 7.5 and no prior diet education.

Mitchell presents for initial nutrition education related to diet for diabetes.

Client states he used to be 500 lbs about 4 years ago. Did intermittent fasting and dropped his weight to about 362 lbs. However, then he was diagnosed with diabetes and fatty liver. He moved from South FL to the Jacksonville area several months ago and fell off track with his eating habits and gained back weight to 395 lbs. Reports lots of indulgent cooking in their much larger kitchen. Works as a manager at Carmax and his meal schedule varies depending on if he goes into work at 7:30am or 1pm. Lately he has been cutting carbs to 30-40 grams per day and has lost about 10 lbs, but is looking for guidance on if his diet is adequate and how to continue losing weight and manage the diabetes. Last A1c was 7.5 but he is not monitoring blood sugars. reports often feeling like his sugars are spiking or feeling "low" when his sugar is around 90. Reviewed ways to improve his blood sugar control without eating too little, and how to promote long-term success with his weight loss.

Noted low vitamin D (now taking 50,000 IU weekly) and B12 (has a multivitamin with B12 but is not consistent with taking it). He will try to take the multivitamin more consistently. Also has history of diverticulitis and GERD, however, he states since starting Nouri probiotic and psyllium fiber capsules daily his GERD has been resolved and he is having more formed stools several times daily. Discussed topics listed below and set goals he personally chose.

Nutrition Interventions:

Reviewed: plate method, general healthy eating, sources of protein, sources of non-starchy vegetables, sources of carbohydrates, sources of healthy fats, label reading, restaurant dining, meal planning, red and processed meat recommendations, beverage choices, snacking, brainstormed meal and snack ideas, exercise and setting a realistic plan, benefits of resistance exercise, hunger/fullness scale, meal timing, prevention and treatment of low blood sugars, insulin resistance, vitamin needs and risks of deficiency, simple vs complex carbs, creating a realistic diet plan and eating adequately

Readiness to change dietary habits: 9

Nutrition Monitoring and Evaluation:

Goals:

  1. Exercise 3 times a week.
  2. Plan dinner to be more than 2 hours away from bedtime.

All questions were answered throughout our session. Client denies any questions or concerns but was encouraged to call if they arise.

Emailed client written materials to reinforce nutrition education: plate method, hunger/fullness scale

Will call for follow up as desired.

Topics Discussed

Diabetes

Appointment History

Number of Sessions: 1

Last Updated: May 10, 2024