ADIME Note: Gestational Diabetes

Pt is a 30-year-old female who has been referred for MNT 2/2 diagnosis of
gestational diabetes (GDM).
Food and Nutrition History:
Pt reported: Previous pregnancies able to keep glucose numbers fairly steady. Most
high readings were 2/2 pt admitted poor eating choices. Prefers salty to sweet. Pt
states she is hungry most of the time and tries to eat regularly. Pt admits to
excessive juice consumption until GDM diagnosis last week. Pt likes grapes,
strawberries, bananas, does not eat beans.
Breakfast- Toast, eggs, bacon or sausage, bagels
Snack- granola bar, grapes
Lunch- Convenience foods several times a week, including McDonalds and Wendys.
Eats a double cheeseburger and fries.
Dinner- Dinner is at home with family and usually protein, starch and tries to include
a vegetable most times.
Anthropometrics:
Height- 65 inches
Current weight- 225 (pt reported)
Pre-pregnancy BMI- 31.9 (Class I obese)
Pre-pregnancy weight- 191
Pt has gained 34 lbs with this pregnancy (currently 28 weeks gestation)
Desirable weight gain for her pregnancy is 11-20 lbs.
Biochemical:
Pt glucose level was 152 while in office. Pt had sub sandwich 30 minutes prior, thus
glucose was expected to be at this level.
Nutrition Focused Physical Findings:
No reported N,V,C,D
No morning sickness
Reported mild fatigue
Pt looked healthy, alert and mentally able to communicate effectively
Medical History:
4th pregnancy
3rd diagnosis of GDM
Pt is taking Flintstone multivitamins, baby aspirin, and a fiber chewable every day.
No other significant medical history reported

Nutrition Recommendations:
Kcal- Pt has gained considerably more weight than is desirable. Pt should not
restrict calories at this time. Typically in the 3 rd trimester an increase of 452 kcals
per day is recommended. 2200kcals meal plan has been recommended.
Protein- 71g/day
Fluid- 1 ml/kcal
Carb- 40% over 3 meals and 3 snacks
Fiber- 30-35 g/day
Nutrition Diagnosis:
Excessive carbohydrate intake related to food and nutrition related knowledge
deficit concerning appropriate amount of carbohydrate intake as evidenced by
dietitian referral, pt admitted confusion of amount of carbohydrate to consume and
pt reported diet history.
Excessive energy intake related to food and nutrition knowledge deficit concerning
energy intake as evidenced by a gain of 34 lbs at 28 weeks gestation, and pt
reported confusion about how many extra calories she needs to consume daily.
Nutrition Intervention:
Provided glucose monitor and instruction on how to use it. Provided journal for
recording glucose readings. Advised pt that glucose test should be performed 4
times a day, upon waking, and 2 hours after breakfast, lunch and dinner. Pt told
what values are desirable (upon waking <95 mg/dl, 2 hours postprandial <120
mg/dl). Pt told what to do if values are <60 mg/dl (consume 4 oz. of juice, wait 15
minutes and retest, if value is still low repeat process). Determined pts level of
knowledge concerning what a carbohydrate is and how much carbohydrate is in
each food group. Reviewed portions sizes of foods and their carbohydrate count.
Gave pt sample diet with carbohydrate choices and calorie requirements. Discussed
eating protein and carbohydrate together as snack. Discussed GDM guidelines and
provided handout. Pt acknowledged understanding, good compliance is expected.
Monitor and Evaluate:
Pt lab values
Glucose levels recorded in journal
Weight gain