CASE STUDY 2 Carbohydrates 

Description:
You are the nutritionist giving advice to only one of the case study scenarios below based on which group you are in.  In these scenarios, the patient has come to you for a consultation.  During the consultation, they tell you about themselves but there is also other information provided. In order to answer the questions, you will need to figure out what information is missing and phrase it as a probing question in order for you to give advice to your patient. For more info see the rubric located under the assignment submission.

Case Study Carbohydrate - Judy:
"My daughter, Hannah, has been pestering me about changing the way we eat and getting more exercise.  She says she is just trying to lose weight, but ever since I learned I have type 2 diabetes, I know she's been worried about me.  What I didn't realize until last night is that she is worried about herself, too.  All through dinner, she was really quiet: then suddenly, she said, 'Mom, I had my fasting blood sugar tested at the health center, and guess what?  They said I have pre-diabetes since my glucose level was 188 mg/dl.  They told me that's the first step towards diabetes and that if I didn't make some serious changes, I would end up just like my mom. I am not sure why, but it made me nervous.’  (Judy takes a deep breath and then tells the nutritionist) “So, I guess we both need to change some things when it comes to eating and exercising.  Trouble is, I don't really know where to start."
Since the pandemic, they have stayed home and mostly eat canned or frozen foods.  They are now trying to eat more healthily since the pandemic has officially ended.  So Judy primarily cooks pasta with some meat and occasionally a vegetable or two.  For breakfast, they typically eat boxed cereals with cold milk.  They also both enjoy eating their favorite dessert while watching TV.  Judy works from home 3 days per week on the computer, and Hannah attends high school but typically comes home right after school. Hannah does not enjoy sports and does not participate in any school sports.  Since the pandemic, Judy and Hannah have gotten accustomed to staying at home.
How would you explain the connection between Hannah’s pre-diabetes with her diabetic mom Judy? What are some of the pre-diabetic symptoms Hannah should be aware of so that she can alert a physician concerning diabetes? What are Judy’s risk factors for type two diabetes? Given what you know about Judy's and Hannah's lifestyle, can you think of changes both mother and daughter could make to start addressing their dietary and physical activity needs?
What are some probing questions you would ask the patient to understand their case better?
Case Study Carbohydrate - Robert:   
“I can’t remember a time in my life when I wasn't trying to lose weight, but nothing ever works!  Last week, I had my annual checkup, and my doctor confirmed what I already knew—I’m obese!  The doctor also said my weight is contributing to my high blood sugar and that my blood pressure is too high.  As a nurse’s aide, I see the health problems caused by obesity every day.  But knowing how bad it is doesn't help me lose and keep weight off.  I need to talk to a nutritionist about a slow and steady strategy for losing weight through diet and exercise.”
Robert is a 66-year-old man, 5 feet 9 inches tall, weighs 254 pounds, BMI is 37.5, serum glucose (Fasting Blood Test) was 169 mg/dl, and A1C was 7.  Robert lives alone in a two-floor home right off the busy main road, close to many homes yet far from stores.  This is not a walking-friendly neighborhood.
Which diet do you recommend and why? Provide three dietary changes he can make with examples of implementing them.  Robert is excited about the prospect of losing weight and is thinking about a goal of losing 10-15 pounds a month, but wants to know your thoughts.  Would you encourage his plan or suggest something different?  Why? What suggestions do you have regarding his physical activity?
What are some probing questions you would ask the patient to understand their case better?

Requirements:

• To answer the questions, use what we learned in class, power points, and the book.  
• Your response should include questions you would probe and ask your patient for more information on their case.  
• Read and answer each questions.  Remember to ask probing questions if you would like to know more information in order to better answer the question. 
• Answer all questions in approximately 300 words, explain and justify your answers. Use correct spelling, punctuation, and grammar. Include probing questions.
• Rubric is located under the assignement submission.
• Either upload the word document to BB or write it out and submit directly in BB.
• Format: MS Word document