Ntr 450 Case Study

Case Study 6.1

1. Did Elizabeth have gestational diabetes

Elizabeth did have gestational diabetes. Two of the four blood glucose levels that she had tested were elevated, which is an indicator of having gestational diabetes. Her one hour after glucose load was 195 mg/dL which is 15mg over that normal glucose level. Secondly her 2 hour after glucose load was 8mg over the normal level putting her at 163mg/dL. As a result of this Elizabeth has an increased risk of preeclampsia so she will be closely monitored (Brown, 2010).

2. Was she insulin resistant?

Yes, she was insulin resistant because as previously stated after she was administered the 100-gram glucose test her blood glucose spiked beyond the acceptable levels. This indicates that the sugar was not being absorbed by the insulin as a result of either lack of insulin or an insulin resistance. As her BMI was only 23.5 her insulin resistance is due to not having enough produced by the pancreas as stated in the book (Brown 2010). This test goes to show that she was in fact insulin resistance and will need to get nutritional therapy in order to help normalize her glucose levels (Brown, 2010).

3. What’s the most likely reason Elizabeth delivered an abnormally large newborn

The most likely reason why Elizabeth gave birth to an abnormally large baby is because the high amounts of insulin in her system lead to increased amounts of glucose uptake by the fetus. This will result in an increased amount of triglycerides from glucose. This increases the likelihood that the fetus will develop diseases like hypertension, type 2 diabetes, and obesity later in life (Brown, 2010).

4. What was wrong with the dietary advice Elizabeth was given

The original advice given was the wrong advice because she was instructed to eat no sugar and a low carbohydrate diet, which is not entirely correct, as the primary goal is to have a normalized blood glucose level. One of the ways to achieve this is by consuming a diet rich in fruits/vegetables, whole grains, and fiber while making sure all foods consumed have a low glycemic index. She should also be encouraged to consume regular meals that are low in simple sugars and saturated fats. Based on these guidelines we can see that the original recommendations would not help the conditions as no fruit or grains would be allowed in the diet (Brown, 2010).

5. List three components of appropriate dietary advice for women with gestational diabetes

There are many ways that a woman can correct her diet to help decrease the severity of her gestational diabetes. She is encouraged to incorporate whole grain foods, vegetables, fruits as well as ingestion of high fiber foods. It is also recommended that she is constantly eating every 2-3 hours and having three regular meals along with snacks in-between those meals. In these meals the main focus is to control the intake of carbohydrates, in doing this it is recommended for 40-50% of the daily intake of calories to be from carbohydrates. The other calories should be 20% from protein and 30-40% from fat. Carbohydrates should come mostly from complex carbohydrates that are also high in fiber, and the fat intake should come from foods that contain a low amount of saturated fat (Brown, 2010).

Life Course Perspective:

The life course perspective is a good representation for this case study because Elizabeth is going through multiple perspectives while she is pregnant. The first one being linked lives, she is now bound to her fetus and responsible for its well-being. Anything that may happen to the fetus as it grows can be a direct correlation to what is done now by the mother. This is directly correlated to the fact that she had gestational diabetes, which then ended up making her baby have a high birth weight. This could then result in the babe have type 2 diabetes, hypertension, or becoming obese later in life. The mother needs proper nutritional management here because the baby is solely dependent upon her.

Citations:

1. Wethington E. An overview of the life course perspective: Implications for health and nutrition. Journal of Nutrition Education & Behavior. 2005 (37:115-120).

2. Devine CM. A life course perspective: Understanding food choices in time, social location, and history. Journal of Nutrition Education & Behavior. 2005 (37:121-128).

3. Brown, JE, et al., editors, 2010, Nutrition through the Life Cycle, 4 thedition, Wadsworth/Thomson Learning, Belmont, CA.

Citations: 1. Wethington E.   An overview of the life course perspective: Implications for health and nutrition. Journal of Nutrition Education & Behavior. 2005 (37:115-120). 2. Devine CM.   A life course perspective:   Understanding food choices in time, social location, and history. Journal of Nutrition Education & Behavior. 2005 (37:121-128). 3. Brown, JE, et al., editors, 2010, Nutrition through the Life Cycle, 4 thedition, Wadsworth/Thomson Learning, Belmont, CA.