Dietary Information, Insulin, and more

Patient Pain and Behavior

When assessing a patient's behavior, consider whether it's typical or influenced by factors like pain or sleep deprivation. Investigate their eating habits, such as consuming high-calorie foods like crackers with butter for quick energy satisfaction.

High-Protein, High-Fat Foods

Companies like SaskTel (Insure) have produced high-protein, high-fat foods (custards) designed for high energy. These foods provide necessary energy without needing to consume meat or salad.

Case Management and Patient Wishes

In a case management scenario, a patient in the ICU held the speaker's hand, indicating a bond due to the absence of other visitors, including her son. Despite the speaker's attempts to coordinate care, the patient's advanced directives were not clearly defined.

Financial Impact of Patient Care

Patient admissions and expenses can skew financial reports, but understanding the context is crucial. Dr. Brinker recognized that high expenses from one patient didn't negate the good work done for the entire patient population.

Mental Status and Disease Processes

When a patient's mental status is compromised, especially in the elderly, it's essential to check for underlying disease processes affecting their cognitive function.

Medications and Geriatric Depression Scale

Medications, especially in the elderly, can impact mental status. The Geriatric Depression Scale is used to assess depression levels.

Dementia vs. Alzheimer's

Dementia is the broad term for cognitive decline, while Alzheimer's is a specific type of dementia.

Macronutrients, Micronutrients, and Water

There are three types of foods: macronutrients, micronutrients, and water. Macronutrients are needed in larger volumes.

Starch Portion

• Serving Size: When looking at a food label, pay attention to the serving size.
• Total Carbohydrate: A slice of bread might have 15 grams of total carbohydrates.
• Magic Number: 15 grams of carbs equals one starch portion.

Examples:

• Apple or Peach: Contains 15 grams of carbs (one starch portion).
• Mandarin Orange: Contains 15 grams of carbs (one starch portion).
• Potato (small): Contains 15 grams of carbs (one starch portion).

Teaching Method: Comparing Bread and Mashed Potato

To illustrate a starch portion, use a slice of toast as a model. The filling is wheat. Removing the wheat and replacing it with mashed potato that fills the same space equals one starch portion. This is how you teach patients who find label reading too intense.

Practical Snack

Items containing 15 grams of carbs are good snacks to carry. Every 15 grams is one starch portion.

Calories in Carbs

• Magic Number: 15.
• Every gram of carb is four calories.
  1 \text{ gram of carb} = 4 \text{ calories}
• An orange contains 15 grams of carbs.
• Calories: 4 \times 15 = 60
  The orange has 60 calories. Pure and unprocessed, straight from the tree.
• Tic Tac candy has very little calorie. Like, the little one has four calories
• Avoid writing four calories for substantial food items in the exam.
• One carb portion is 15 \times 4 = 60 \text{ calories}

Protein Portion

• Magic Number: 7.
• Seven grams of protein make one protein portion.
• String Cheese: Commonly contains seven grams of protein (one protein portion).
• Example: A food item with 21 grams of protein is three protein portions (3 \times 7 = 21).
• Every gram of protein is also four calories.
  1 \text{ gram of protein} = 4 \text{ calories}
• 4 \times 7 = 28, but this calculation doesn't represent the total calories because of the presence of fat.

Fat Digestion and Insulin

Fats are digested in four to five hours, with 10% converting to sugar. Insulin is not needed to use fat or protein by the cells; it is only required for carbs.

Fat Portion

One teaspoon of peanut butter, containing five grams of fat, is one fat portion.

Insulin and Carb Ratio

Naturally, the body produces one unit of insulin for every 15 grams of carbs. Thus, 15 grams of carb requires one unit of insulin.

Meal Example and Insulin Calculation

Consider a breakfast with bread, an orange, bologna, and cheese:

• Carbs: Bread and orange.
• Protein: Bologna and cheese (can be fat if low-fat).

If a patient's blood sugar before the meal is 120 (a good goal), eating this meal will increase sugar levels, requiring insulin.

• Carb Portions: Three (two from bread, one from orange; 15 \text{ grams} \times 3 = 45 \text{ grams}. Hence, three units of insulin are needed, as the pancreas naturally releases one unit per 15 grams of carb.
• Doctor's Orders: If a doctor prescribes six units of Humalog, evaluate if it's appropriate. A thin person might need three units, but a heavy person with central obesity may need more because fat makes insulin work harder.
• Clinical Judgment: Collaborate with the healthcare team. If a thin, elderly patient with non-central obesity is prescribed six units, suggest to the doctor that it may lead to hypoglycemia, given the patient is only eating three carb portions.

Insulin Phases and Glucose Utilization

The pancreas has ready insulin, known as the first phase. When eating, insulin and glucose work together, prioritizing the brain for energy. Next, the liver converts glucose into glycogen through glycogenesis.

Fasting State and Glycogenolysis

During the fasting state (e.g., sleeping), glycogen turns back into glucose through glycogenolysis.

Glycogen Storage and Utilization

The liver can store a maximum of 365 grams of glycogen, varying by individual based on their daily intake. If all 365 grams are depleted without eating (approximately 13 hours), the body starts burning fat.

Gluconeogenesis

Fat converts into glucose through gluconeogenesis. The prefix "neo" means new.

Plate Composition

• Vegetables: Half of the Plate.
• Carbohydrates: One-quarter of the plate (rice, beans, bulgur, quinoa).
• Protein: One-fourth of the plate
• Fruit: Should generally be on the side/separate.

A quarter plate of grain is two bread portions.

Carbohydrate Portions Per Meal

Maximum four portions per meal:

• Grains: Two portions.
• Fruit: One portion.
• Yogurt: One portion.

Vegetables are not counted due to their high-water content, except for corn, peas, and beets.

Fruit Portions

Anything that is ten small is one portion.

Protein Calories vs. Total Calories

Three protein portions equal 21 grams of protein, but the total calories are more than 21 due to the presence of bone, meat, and fat.

BMI

• Overweight BMI
• Obese BMI