Case Study #1: Type 2 Diabetes

Case Study: Type 2 Diabetes

This is an overview of an actual patient from Dr. John Fitzgerald DC.  You are encouraged to show this to your doctor and work out a plan with your doctor.

The plan below is a typical plan that Dr. Fitzgerald uses to help his diabetic patients.

 

Synopsis:

Patient is a 69 yr old female with diabetes.  She had been on insulin for a few years.  She was told that her pancreas is full of cysts and that it no longer produces insulin.

She complains that she gets shaky between meals (especially between breakfast and lunch).

 

We made these modifications to her diet:

Reduce the hours of the day she eats in to a 6-hour window.  The goal is to eat all her food for the day between noon and 6 pm.

• The other major modification was to start drinking a superfood smoothie for lunch. She used the My Nutrition Advisor smoothie recipes for Diabetes and always added the optional protein.
• Stop drinking diet soda and start drinking green tea.
• Sprinkle cinnamon in her black coffee
• Take diabetes targeted supplements. (Alpha Lipoic Acid, Chromium, Magnesium, B-vitamins, Vitamin D)

 

Results were noticed in less than a week:

She noticed that she felt better right away.  She stopped feeling shaky between meals.  She sleeps better, thinks more clearly and has more energy.

 

Before – “Typical Day” insulin totals

Levemir (Insulin) – 30 units

Humalog (Insulin) – 16 units

total = 46 units of insulin per day

 

After – “Typical Day” insulin totals

Levemir (Insulin) – 0 units

Humalog (Insulin) – 9 units

total = 9 units of insulin per day

The example below shows how she made some modifications and what happened to her blood sugar levels.  She was amazed how much the superfood smoothie helped her feel better and lower her blood sugar levels, while eating ice cream did exactly the opposite.

 

Before: Typical Day before she made modifications

She usually eats in a 12-hour window.  She starts eating at 8 AM and finishes at 8 PM.

She takes two types of insulin.  One big amount in the morning called Levemir and small amounts of Humalog before each meal.

She doses Humalog based on what she eats and how high her blood sugar is before each meal.

 

Patient habits:

7 AM Levemir (insulin) – 30 units

8:25AM Right before eating: blood sugar approx. 165

Plan: Decide what to eat and then adjust medication based on what she ate and what blood sugar was.  Humalog (insulin) – correct blood 161-190 take 2 units for that. Take 1 unit for every 15 grams of carbs at the upcoming meal.

Actual: (Usually takes 2 units for correction and takes 2-4 units for the upcoming meal.  Total units taken at this time is 4-6 units)

8:30 AM breakfast – egg/ toast or cereal/milk/banana

 

Eat again, 4-5 hours after first meal

12 – 1 PM Eat

Blood sugar varies but is approximately 100 at this time of the day.

Plan: Decide what to eat and then adjust medication based on what she ate and what blood sugar is.  Humalog (insulin) – correct blood (no extra insulin required until blood sugar reaches 131). Take 1 unit for every 15 grams of carbs at the upcoming meal.

Actual: (Usually takes 0 units for correction and takes 4 units for the upcoming meal.  Total units taken at this time is usually 4 units)

Meal varies greatly

 

Eat again, 4-5 hours after last meal

5 – 6 PM Eat

Blood sugar varies but is approximately 100 at this time of the day.

Plan: Decide what to eat and then adjust medication based on what she ate and what blood sugar is.  Humalog (insulin) – correct blood (no extra insulin required until blood sugar reaches 131). Take 1 unit for every 15 grams of carbs at the upcoming meal.

Actual: (Usually takes 0 units for correction and takes 4 units for the upcoming meal.  Total units taken at this time is 4 units)

Meal varies greatly

 

Eat again, 2-3 hours after last meal

8 PM Eat

Blood sugar – doesn’t measure it

Plan: Decide what to eat and then adjust medication based on what she ate.  Humalog (insulin) – Take 1 unit for every 15 grams of carbs at the upcoming meal.

Actual: (Usually takes 2 units for the upcoming meal.  Total units taken at this time is 2 units)

This snack is usually popcorn or ice-cream

 

Before – “Typical Day” insulin totals

Levemir (Insulin) – 30 units

Humalog (Insulin) – 16 units

 

After: Implementation of Dr. Fitzgerald’s eating strategy

Goal is to spend more time with blood sugar between 70-99.  This greatly reduces the damage from Diabetes and may allow her to take less insulin.

Her goal is to eat within a 6-8 hour window.  That means her first meal will be between 10 AM and noon.  Her second meal will be around 6 PM.

 

She is going to drink black coffee for breakfast with a tiny bit of cinnamon added.  She may also add 1-2 spoonfuls of coconut oil.  (Cinnamon helps to regulate blood sugar)

For lunch, she is going to have a superfood smoothie from the Type 2 diabetes smoothie recipes.

For dinner, her meal will vary greatly, However, she should focus more on a variety of vegetables and meat.

 

Here is what she did her first week:

Day 1: (Saturday)

7:30 AM Levemir (insulin) – 30 units

9:00AM Right before eating: blood sugar approx. 134

Breakfast – 2 eggs/ 1 toast.  Had 2 cups of black coffee.

She took Humalog (insulin) to correct blood (131-160) by taking 1 unit of insulin. Also, took 2 units for every 15 grams of carbs at the upcoming meal.

Total units taken at this time was 3 units.

2:00PM blood sugar 117

Decided not to eat because her blood sugar was already higher than 99 and she knew that eating would raise her blood sugar level even higher.

5:30PM blood sugar 80 (Blood sugar was now in an ideal range)

6:30 PM Dinner: Steak, Salad, 1 cup scallop potatoes

Did not take insulin at this meal because her blood sugar was below 131.  She decided to see what happens by not accounting for the carbs in the potatoes with insulin.

 

She never tests blood sugar after meals.  Today she decided to do so to see what happens.

7:30PM blood sugar 176 (1 hour after eating)

8:30PM blood sugar 189 (2 hours after eating)

9:30PM blood sugar 167 (3 hours after eating)

10:30PM blood sugar 137 (4 hours after eating)

 

 

Day 2: (Sunday)

7:30 AM blood sugar 148 (13 hours after eating)

Notice that when she went to bed her blood sugar was 137 and when she woke up her blood sugar was 148.  This is a typical response that can be attributed to the hormone (cortisol) being released in the morning hours.

She did not take insulin to see how her body reacted.  She will start adding it back based on blood sugar levels.

Had 2 cups of black coffee with cinnamon added.

12:15 PM blood sugar 111

She did not need to correct blood sugar with insulin because it was below 131.

She did not take insulin at this meal to account for carbs eaten because she wanted to see how she responded after a smoothie.

12:30 PM Lunch – 2 servings of Banana Bread superfood smoothie.  3 TBSP of Smoothie Protein was added to the recipe.

3:00 PM blood sugar 177 (1.5 hours after eating)

4:30 PM blood sugar 108 (3 hours after eating)

6:00 PM blood sugar 87 (4.5 hours after eating)

6:30 PM Dinner: Salmon, Salad, 1/2 cup scallop potatoes

Did not take insulin at this meal because her blood sugar was below 131.

10:45 PM blood sugar 146 (4 hours after eating)

(Notice that her body responded better after eating the smoothie at lunch than the food meal at dinner.  It should also be noted that the smoothie had a banana and a date in the recipe)

 

 

Day 3: (Monday)

8:00 AM blood sugar 147 (13 hours after eating)

Did not take Levemir insulin because her blood sugar is 147 and she would drive her blood sugar too low by taking her normal dose of 30 units.  She may need to take a smaller dose of Levemir in the days to come.  She will base it off her blood sugar levels.  What she is noticing is that her blood sugar levels have improved and she is not taking insulin.  She changed her food choices by adding a superfood smoothie at lunch and is eating in a 6-hour window.

Had 2 cups of black coffee with cinnamon.

12:00 PM blood sugar 153

She did not take insulin on this meal because she wanted to see how she responded after another smoothie.  She will likely start adding back some insulin tomorrow as her blood sugar should be between 70 and 100 before lunch.

12:00 PM Lunch – 2 servings of Banana S’mores superfood smoothie.  3 TBSP of Smoothie Protein was added to the recipe.

She did not eat dinner today.

 

Day 4: (Tuesday)

8:00 AM blood sugar 176 (13.5 hours after eating)

She took 2 units of Humalog (insulin) to correct her blood sugar (161-190) based on her correction chart.

Had 2 cups of black coffee with cinnamon.

12:30 PM blood sugar 124

Took 2 units of Humalog (insulin) for the upcoming meal.

She ate 1 servings of The Hangover superfood smoothie.  1 TBSP of Smoothie Protein was added to the recipe.  Also at a handful of peanuts.

4:30 PM Right before eating: blood sugar 109

She took 2 units of Humalog (insulin) for the upcoming meal.

She ate 1 slider (small hamburger), a small french fries, and 1/2 cup garlic soup.

8:00 PM Had a Teavana tea.  Later found out that sugar was added.

10:30 PM Blood sugar 113

 

Day 5: (Wednesday)

8:00 AM blood sugar 147 (13 hours after eating)

Did not take Levemir insulin because her blood sugar is 147 and she would drive her blood sugar too low by taking her normal dose of 30 units.

Had 2 cups of black coffee with cinnamon.

6:30 PM Right before eating: blood sugar 96

Did not take insulin on this meal because she wanted to see how she responded after this meal.

Dinner – Chicken, salad, mixed vegetables, pita bread with greek yogurt spread.

11:00 PM blood sugar 232 (4.5 hours after eating) – She took 4 units of Humalog (insulin) to bring down her blood sugar.  Eating pita bread at the meal caused her blood sugar to elevate.  She is learning how her blood sugar responds to what and how much she eats.

Tomorrows plan is to start taking the insulin before each meal.  She has learned that her blood sugar is better going longer periods between each meal and not eating bread.

 

Day 6: (Thursday)

7:30 AM blood sugar 142

She took 1 unit of Humalog (insulin) to correct her blood sugar (131-160) based on her correction chart.

Had 2 cups of black coffee.

She started to add Supplements to her regiment

1. Lipoid Acid (Alpha Lipoid Acid) – take 1 pill per meal = total of 2 pills per day
2. Biomega 3 (Fish Oil) – take 1 pill per meal = total of 2 pills per day
3. Bio D Mulsion Forte (Vitamin D) – take 1 drop per meal = total of 2 drops per day
4. Glucobalance (Multi vitamin for Diabetics) – take 3 pills per meal = total of 6 pills per day

12:30 PM blood sugar 119

She took 2 units of Humalog (insulin) for the upcoming meal.

12:30 PM Lunch – 1.5 servings of Banana Bread superfood smoothie.  1 TBSP of Smoothie Protein was added to the recipe.

6:30 PM blood sugar 104

She took 4 units of Humalog (insulin) for the upcoming meal.

7:30 PM Dinner – New Year’s Eve party and a lot of bad food was eaten including deserts.  General Tsoas chicken, cheese ragoons, lettuce wraps, lemon pie, a cupcake etc.

10:30 Blood Sugar 178 – took 2 units of insulin for correction

 

Day 7: (Friday)

8:00 AM blood sugar 142

Had 2 cups of black coffee with cinnamon, 1 egg, 1 sausage. 

2:30 PM Right before eating: blood sugar 104

She took 4 units of Humalog (insulin) for the upcoming meal.

Lunch – at a New Year’s Day party.  Fried chicken, garlic soup, lettuce wraps

6:30 PM blood sugar 87

Plan: Decide what to eat and then adjust medication based on what she ate and what blood sugar was.  Humalog (insulin) – Take 1 unit for every 15 grams of carbs at the upcoming meal.

She took 1 unit of Humalog (insulin) for the upcoming meal.

Dinner – had 1 cup of ice cream

11:30 PM blood sugar 151 (She did not respond well to the ice cream.  She realized that she should avoid ice cream)

 

Day 8: (Saturday)

8:30 AM blood sugar 154

8:00 AM Humalog (insulin) – took 1 unit of Humalog (insulin) for correction. 

1:30 PM blood sugar 120

She took 4 units of Humalog (insulin) for the upcoming meal.

3:00 PM Lunch – had a banana bread superfood smoothie.  Added 2 TBSP of Smoothie Protein.

5:30 PM blood sugar 93

 

3 Week Update

She reports that she continues to have improved blood sugar levels and has lost 10 lbs.