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Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "

Case study ( 11481 views as of December 21, 2024 )

John is 55 years old and was recently diagnosed with Type 2 Diabetes. For several years his family physician has warned him that he was at high risk of developing Type 2 Diabetes due to a strong family history of Type 2 Diabetes, his age and obesity. John is 5 feet 9 inches and 220lbs, giving him a BMI of 32.7. His family physician has encouraged him to lose at least 5% of his weight (11 lbs) to reduce his risk of developing Type 2 Diabetes. Although John has made some attempts to lose weight, he has not been very motivated and has never lost more than 5 lbs before regaining the weight back.

Today John is in to see a registered dietitian to learn more about healthy eating to manage his blood glucose and to lose weight. His family physician has given him 3 months to try and manage his blood glucose before starting medications. He has been testing his blood glucose at home occasionally and is frustrated that his numbers are above target because he tells the dietitian that he doesn’t eat sweets.

After a review of John’s diet, the dietitian identifies a few areas that John can focus on to improve his blood glucose. Although John eats an overall balanced diet and limits his intake of sweets and treats, he does have large portions and often drinks fruit juices.

John does not do any regular physical activity at this point in time. He expresses more motivation now then ever before to lose weight as he is afraid of developing the complications of diabetes and wants to know what he should to do improve his blood glucose.

John could benefit from seeing an endocrinologist to discuss treatment options for diabetes management and complication prevention. He would also benefit from seeing a Certified Diabetes Educator (registered nurse and/or registered dietitian) to support him in managing his diabetes at home on his own. Continuing to follow-up with a registered dietitian would help him make necessary changes to his diet for better blood glucose control and weight loss. A personal trainer could help him start a regular exercise routine that would meet his needs. It may also be beneficial for John to see an ophthalmologist and dentist for baseline screenings, or to uncover any associated conditions like diabetic retinopathy and gum disease.

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Conversation based on: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "

Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "

  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 June 2023
    The glycemic index (GI) ranks foods on a scale of 0 to 100 based on how quickly and significantly they raise blood sugar levels compared to a reference food (usually glucose or white bread). Foods with a high GI value are quickly digested and absorbed, leading to a rapid rise in blood sugar levels, while foods with a low GI value are digested and absorbed more slowly, resulting in a more gradual increase in blood sugar levels. Choosing foods with a low glycemic index can help prevent sharp spikes in blood sugar levels and provide more sustained energy. High-fiber foods, whole grains, and foods with a lower carbohydrate content tend to have a lower glycemic index. It's important to note that the glycemic index is just one tool to consider when planning meals, and individual responses to foods may vary. In addition to selecting low glycemic index foods, it's also important to focus on overall healthy eating patterns for managing diabetes. This includes incorporating a variety of nutrient-dense foods, practicing portion control, balancing meals with protein, healthy fats, and fiber, and working with a registered dietitian or healthcare provider to develop a personalized meal plan. If you have specific questions about the glycemic index or need guidance in managing your diabetes through diet, it's best to consult with a registered dietitian or your healthcare provider who can provide tailored advice based on your individual needs and goals.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 28 April 2023
    The Benefits of Squash in Your Diet Squash is a great addition to any healthy diet. There are many varieties of squash and we tend to group them into the winter and the summer selections. Local Nutritionist You have common varieties like the zucchini, pumpkin and butternut squash, but you can also find some less common varieties such as spaghetti squash, yellow squash and acorn.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Dr. David Maberley MD, FRCS(C), MSc
    Dr. David Maberley MD, FRCS(C), MSc Ophthalmologist, Ottawa, ON 18 December 2019 Ottawa Hospital Ophthalmology
    A disease that occurs when the pancreas does not produce enough insulin to meet the body’s needs and/or the body is unable to respond properly to the actions of insulin (insulin resistance). Type 2 diabetes usually occurs later in life (although it can occur in younger people) and affects approximately 90% of people with diabetes. There is no cure. It is treated with careful attention to diet and exercise and usually also diabetes pills (oral antihyperglycemic agents) and/or insulin.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Dr. David Maberley MD, FRCS(C), MSc
    Dr. David Maberley MD, FRCS(C), MSc Ophthalmologist, Ottawa, ON 18 December 2019 Ottawa Hospital Ophthalmology
    People with diabetes should get their eyes checked at least once per year by a qualified eye doctor (optometrist or ophthalmologist). If necessary, the eye doctor may recommend more frequent eye examinations, but once per year is the very minimum.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Dr. Ronald Goldenberg MD, FRCPC, FACE
    Dr. Ronald Goldenberg MD, FRCPC, FACE Endocrinologist, Thornhill, ON 09 December 2019
    A disease that occurs when the pancreas does not produce enough insulin to meet the body’s needs and/or the body is unable to respond properly to the actions of insulin (insulin resistance). Type 2 diabetes usually occurs later in life (although it can occur in younger people) and affects approximately 90% of people with diabetes. There is no cure. It is treated with careful attention to diet and exercise and usually also diabetes pills (oral antihyperglycemic agents) and/or insulin.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 April 2022
      People with type 2 diabetes aren't at risk of blindness from diabetic retinopathy.
  • Dr. Duncan Miller MD
    Dr. Duncan Miller MD Family Doctor, Vancouver, BC 08 December 2019 Broadway Plaza Family Practice Vancouver
    A hand-held machine designed to test blood glucose levels. A drop of blood (usually from the fingertip) is placed on a small test strip that is inserted into the meter. The meter displays the amount of glucose in the blood. Blood glucose meters allow people with diabetes to play an active role in monitoring and managing their own blood glucose levels
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 April 2022
      Diabetic retinopathy affects the blood vessels in the eye.
  • Dr. Richard Bebb MD, ABIM, FRCPC
    Dr. Richard Bebb MD, ABIM, FRCPC Endocrinologist, Victoria, BC 07 December 2019
    A disease that occurs when the pancreas does not produce enough insulin to meet the body’s needs and/or the body is unable to respond properly to the actions of insulin (insulin resistance). Type 2 diabetes usually occurs later in life (although it can occur in younger people) and affects approximately 90% of people with diabetes. There is no cure. It is treated with careful attention to diet and exercise and usually also diabetes pills (oral antihyperglycemic agents) and/or insulin.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 31 May 2017
    A good friend of mine who is 60 was just diagnosed and it was a big shock to him.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 April 2022
      There are two types of diabetic retinopathy: early diabetic retinopathy and advanced diabetic retinopathy.
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 April 2022
      Diabetes is the number one cause of blindness in the working-age group worldwide.
  • K. Michael
    K. Michael 10 December 2015
    My dad has type 2 diabetes and his doctor recommended that he begin to wear the support socks. What is the difference between diabetic socks and the compression stockings ?
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Michelle Kaarto, BScK, CSEP CEP
    Michelle Kaarto, BScK, CSEP CEP 28 October 2015
    John should also be taught the importance of foot care and educated on the warning signs of poor circulation and sores or ulcers on the feet. Along with regular exercise and diet and blood sugar control, John needs to practice good foot care. My father has had diabetes for 30 years and had to have all of his toes amputated in the past year due to circulation problems.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 13 November 2015
      Absolutely @K.Michael!! Diabetics can lose sensation in their feet as their circulation worsens, and they would be less likely to notice a cut on their foot. Left unnoticed or untreated, this cut can easily turn into an infected one, which can lead to serious issues. Foot care in diabetics should be a priority, and it's great that your aunt has someone coming in for home support to help her.
    • K. Michael
      K. Michael 07 November 2015
      My aunt has a number of health issues and has someone from CCAC come in on a monthly basis to help with her feet. Would this be something a diabetic could benefit from ?
  • K. Michael
    K. Michael 05 October 2015
    The recommendation that John see an ophthalmologist is such an important one. My father was experiencing on and off issues with his vision that he never associated with the fact that he was pre-diabetic. He now has permanent damage to his vision
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Ashley Grachnik
      Ashley Grachnik Registered Dietitian, Toronto, ON 27 October 2015
      Thank you for your comment and sorry to hear that your father has some vision damage. The 2013 Clinical Practice Guidelines indicate that people with Type 2 Diabetes should have their eyes checked annually to assess for early signs of damage from Diabetes. This helps prevent issues from Diabetic Retinopathy and other associated eye disease.
  • AllieS
    AllieS 08 August 2015
    As has been said, getting the motivation to increase physical activity can be difficult. John might benefit from group exercise, where everyone present is in a similar situation. Encouragement and support from peers may be what he needs to stick to an exercise routine. In addition, taking part in activities that he genuinely enjoys will go a long way. Making exercise something to look forward to, instead of an obligation, will help boost John's motivation to be active. In terms of his diet, perhaps he could start to cut out the fruit juice by diluting his portions with water so that he gradually consumes less and less sugar.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • K. Michael
      K. Michael 11 August 2015
      Or perhaps switching his juice to smoothies that will up his vitamin and vegetable intake
  • K. Michael
    K. Michael 22 July 2015
    Exercise doesn't have to mean being stuck in a gym. In addition to speaking to a personal trainer or dietitian he should look outside the box at activities like boxing, fencing, soccer or rugby.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
  • Joy
    Joy 24 April 2015
    Increasing his water intake should naturally lower his fruit juice consumption. He should start with aiming to get in 2 liters of water daily. After drinking 2 liters, there isn't enough time in the day to drink anything else!
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • ShirleyG
      ShirleyG 04 May 2015
      This is a great suggestion. It will help quench your thirst without extra sugars and calories.
    • K. Michael
      K. Michael 30 April 2015
      This is very true. Herbal ice teas sweetened with agave or honey are also good substitutions if you can't go straight to just water. It's much better than drinking soda and other sugary drinks
  • Joy
    Joy 01 April 2015
    I think that John needs to make some changes using baby steps. We don't want to place radical changes on him swiftly, or he will not stick with his new regime again. Perhaps a good starting point would be to change a few eating habits (like adding more vegetables to meals) and walking for deliberate exercise a few times per week. When these changes become his new norm, more changes can slowly be introduced.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Ashley Grachnik
      Ashley Grachnik Registered Dietitian, Toronto, ON 26 April 2015
      Good point! Small changes that are realistic and achievable will set John up for success and he can build on these successful changes as time moves on. It is also important to think about some potential obstacles and have a plan to overcome them in order to stay on track with healthy changes.
    • K. Michael
      K. Michael 01 April 2015
      This is such a good point. When my father received his diabetes diagnosis he felt he was being told to change everything. As a result he rebelled and refused to change anything. Working the changes in, in baby steps, is a much easier way to ensure lasting change.
  • K. Michael
    K. Michael 27 March 2015
    The case study indicates that John has attempted to lose weight several times but always ends up gaining the weight back. It seems like this time he might have the drive required to make lasting changes to his eating
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 28 October 2015
      I think John might benefit from consulting a Wellness Coach - someone who is qualified to help guide him through making these small changes in his lifestyle to improve his overall health. A wellness coach can help John channel his motivation into actually effecting some good changes, and break his efforts into chunks/goals so that he can work on gradually getting to his ultimate goals.
    • ShirleyG
      ShirleyG 01 April 2015
      What are some suggestions that John can be given to ensure he stays on track ? It is hard for an individual to come up with a plan and stick to it, however if it is something they find easy then it is more likely they will stick to the routine.
  • Dr. Richard Bebb MD, ABIM, FRCPC
    Dr. Richard Bebb MD, ABIM, FRCPC Endocrinologist, Victoria, BC 19 March 2015
    Although historically we've used body mass index as part of the criteria to diagnose obesity, again a BMI over 30 as being diagnostic, in fact, BMI has been criticized as an imperfect measure. It doesn't account for muscle, so an individual with a large muscle mass will have a higher BMI, but actually not an increased risk.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 28 October 2015
      Waist circumference has been singled out as a predictor of risk for various health conditions, whether it's diabetes, high cholesterol, high blood pressure or heart disease. BMI is a simple calculation that most people can figure out at home, however more and more research seems to be emerging to support the measuring of waist circumference. I teach all my clients how to properly measure their waist circumference at home, as many people are measuring incorrectly.
    • Ashley Grachnik
      Ashley Grachnik Registered Dietitian, Toronto, ON 26 April 2015
      Excellent point. We need to include other measures such as waist circumference and activity level in our assessments to have a full picture of a patient's health status. BMI alone is not always enough.
    • Joy
      Joy 01 April 2015
      I agree. BMI alone doesn't give the full overall health picture.
  • Michelle Kaarto, BScK, CSEP CEP
    Michelle Kaarto, BScK, CSEP CEP 17 March 2015
    I think John should be referred to an exercise specialist to help him develop some strategies around adding physical activity to his lifestyle. A simple tool would be to give him a pedometer and have him log his current daily step count. This can be a basic starting point for John to try and move more throughout his day. Having the number at the end of the day is instantly gratifying when it shows an increase and he could use this as a motivator toward sticking with his healthy lifestyle changes.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • K. Michael
      K. Michael 27 March 2015
      This is a great suggestion. Oftentimes exercise is one of the first suggestions when people are diagnosed with a medical condition but it can be difficult to find a starting point. An exercise specialist would be incredibly helpful
    • ShirleyG
      ShirleyG 23 March 2015
      This was suggested to a friend and a goal was set by her family doctor. She had to walk x steps the first week, then it increased by 10% the second week, another 10% the third week and now the 4th week her goal is another 10%. Her doctor has told her to maintain the 4th week goal moving forward and to increase the speed or amount of steps as she sees fit. She is excited by this and has been using the Fitbit to track this, along with her sleep, etc.
  • K. Michael
    K. Michael 13 March 2015
    It's very important to have a full health care team when dealing with a diabetes diagnosis. My father was recently diagnosed with diabetes. He was pre-diabetic for a number of years but didn't disclose that to his dentist or ophthalmologist. It turns out he was experiencing diabetic issues in those areas that could have been handled much better if everyone was aware of his condition.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • Joy
      Joy 01 April 2015
      I didn't realize how many facets of our health that diabetes affects. It is very important to make sure that your whole health care team is involved.
    • Dr. Richard Bebb MD, ABIM, FRCPC
      Dr. Richard Bebb MD, ABIM, FRCPC Endocrinologist, Victoria, BC 19 March 2015
      If you have any questions about obesity, the measurement or treatment of it, please do discuss it with your primary care practitioner.
    • Dr. Richard Bebb MD, ABIM, FRCPC
      Dr. Richard Bebb MD, ABIM, FRCPC Endocrinologist, Victoria, BC 19 March 2015
      It is fat that carries with it an increased insulin resistance, makes it harder to metabolize sugar, makes it more likely you're going to get diabetes, high blood pressure, high cholesterol, heart disease, and increased risk of cancer. So how much fat you have is very, very critical.
  • K. Michael
    K. Michael 08 March 2015
    Regular visits to the dietitian can help John make the necessary changes to his diet that will help get his numbers on target.
    Reply to: Managing a Type 2 Diabetes Diagnosis " John 55 years old recently diagnosed with Type 2 Diabetes "
    • ShirleyG
      ShirleyG 23 March 2015
      By setting up visits to a Dietitian and assisting with a food management program John will be able to get himself on track. John also needs to understand that diet and some exercise go hand in hand in losing weight and maintaining a healthy lifestyle.
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 17 March 2015
      I strongly feel the consistent follow-up is crucial to helping John stick with his goals. He can use the dietitian to ask questions, share successes and challenges, and brainstorm in order to face perceived obstacles and tweak his plan to suit his needs.
    • Ashley Grachnik
      Ashley Grachnik Registered Dietitian, Toronto, ON 11 March 2015
      Thanks K. Michael. I agree that regular visits with the Dietitian are very helpful. The Dietitian can offer education, support and come up with strategies to overcome obstacles to eating healthy.

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