Member Satisfaction
Diagnosis: Diabetes, hyperlipidemia, chronic liver disease
Background:
At time of referral, this patient had a history of high blood pressure and obesity and was just diagnosed as having type II diabetes. She was thought to have liver disease as her enzymes were elevated. The patient reported her total cholesterol level was elevated to 212, and triglycerides were also elevated. Her liver problems prevented her from taking a stating medication for cholesterol management. The patient had a poor understanding of dietary guidelines for cholesterol management. She described herself as Polish/Hungarian, and admitted to eating a large quantity of sausages, fried potatoes, pastries, and baked goods high in fats and cholesterol. She was obese, and had not been exercising. She had tried dieting in the past with little success. The patient was being considered for medication to treat her diabetes.
Interventions:
CM provided the patient with information on the importance of early diagnosis of her liver problems, provided information on diagnostic tests including her upcoming liver biopsy, and gave her information on pre and post-operative considerations. CM provided simple suggestions to help increase daily activity level, including taking short walks, parking further away in the parking lot, and using stairs instead of the elevator in order to help achieve improved stamina and endurance. CM provided the patient with comprehensive educational material on cholesterol management, including dietary guidelines and suggestions on cooking methods that help to reduce fat and cholesterol in foods. CM reviewed dietary guidelines for lowering cholesterol, discussed "healthy fats" to use to maintain an adequate HDL level, and encouraged the patient to exercise. CM recommended diabetic dietary teaching through formal nutrition classes held at the hospital and provided the patient with information on attending these classes. CM assisted the patient in obtaining a glucometer and arranged for finger stick training through her primary physician's office. CM explained the need for close glucose monitoring as the patient was working to control her diabetes without medication. CM helped the patient understand information provided through her diabetes classes and encouraged the patient in addressing her weight issues in order to increase the patient's chances of managing her diabetes without need of medication.
Results:
The patient completed several rounds of testing for her liver problems and was found to have a fatty liver, but no active disease. She drastically modified her diet to avoid sources rich in fats and cholesterol and began making healthier food choices as well as practicing portion management. She attended the diabetes classes as recommended, and is incorporating the information into her life. She walks between 3- 5 miles each day, is following dietary guidelines, and the husband signed her back up with the gym so she could begin cardio workouts with a trainer. She is now going to the gym at least 4 days weekly and following the cardio and weight program recommended by her trainer. She has lost a total of 19 lbs since starting her exercise regimen The patient reports her cholesterol levels and triglyceride levels are within normal limits without medication.
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