Emanuel is a 47-year-old male of Mexican descent who was re

Emanuel is a 47-year-old male of Mexican descent who was referred… Emanuel is a 47-year-old male of Mexican descent who was referred for management of uncontrolled diabetes. He was diagnosed seven years ago and has already started having some blurry vision related to diabetic retinopathy. His hemoglobin A1C keeps increasing and his doctor wants to put him on basil insulin. Emanuel wants to prevent long term complications of diabetes and he is hoping to not have to take insulin. His medical history includes hyperlipidemia, hypertension (HTN), obesity, depression and fatigue. He is divorced with two grown children, lives with his brother and works in overnight shift (11 pm to 7 am) as a nursing assistant at an assisted living facility. His father also had diabetes and passed away 6 months ago from a myocardial infarction. He is still feeling very stressed and having a hard time dealing with his grief. Emanuel just changed his diet and has stopped eating at work, except for a piece of fruit, to try to lose weight and reduce his blood sugar. The only physical activity he gets is walking around at work.Anthropometrics:Height: 5 feet 7 inches/170 cmWeight: 243 lbs/110.4 kgBMI: 38.1Emanuel says he has always been heavy since he was a child. His usual adult weight has been around 220 lbs, but his weight started increasing after his father died. Since changing his diet 2 weeks ago, he has lost 6 pounds/2.7 kg.Here Is Emanuel’s 24-Hour Recall:3:00 pm: 24 oz (700 mL) coffee with half and half (cream and milk) and a bagel with ham and cheese10:00 pm: 2 cups white rice, 2 eggs and 4 oz/115 g chorizo (sausage) with a white flour tortilla. Likes to have something sweet afterward such as 4 mini candy bars and 1 small bag of jelly beans.3:00 to 4:00 am: sometimes has an orange or an appleHas 3 cans sparkling water per day (36 oz/1 L)Medications and Supplements: Metformin 500 mg twice daily, Lisinopril 20 mg, Simvastatin 40 mg, Sertraline 50 mg. He is also taking a multivitamin.Nutrition Physical Exam: Emanuel has a larger body habitus with abdominal fat distribution. He has acanthosis nigricans visible on the back of his neck.   Recent Labs and Blood Pressure:Emanuel self-monitors his blood sugar (SMBG) in the morning about three times a week. He says that he doesn’t like to measure it because it is always high (200 to 300 mg/dL range).Emanuel’s ValueNormal Range for DiabetesFasting glucose 229 mg/dL80 to 130 mg/dLHemoglobin A1C 9.6%Less than 7%Cholesterol 220 mg/dLLess than 200 mg/dLHDL 46 mg/dLGreater than 40 mg/dLLDL 137 mg/dLBelow 130 mg/dL is idealTriglycerides 187 mg/dLLess than 150 mg/dLBlood Pressure (BP): 132/92 1. Assess Emanuel’s anthropometrics and calculate his calorie, protein, and fluid needs.2. Assess his 24-hour recall; is his calorie, protein, and fluid intake appropriate for his needs? Are there any nutrients of concern for his lifecycle stage and state of health (diabetes, hyperlipidemia, HTN).3. Assess his labs and blood pressure, what in his diet and lifestyle could contribute to these values?4. Assess for any potential drug nutrient interactions (DNIs) and side effects.5. Outline your short-term and long-term goals for Emanuel to help him manage his diabetes, elevated blood lipids, and blood pressure. How would you write a SOAP or ADIME note to correspond to this case.Biology Science Genetics NUTR 06202

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