Patient information: D.E., male; age, 54 years; Height, 173.7 cm; Weight 80.4 kg; Blood pressure 142/86 mmHg; Works for large supermarket.
History of present illness: Diagnosed with type 2 diabetes ~20 years ago.
Oral hypoglycemic agents from age 40 years; Insulin from 6 years ago.
Blood glucose not well controlled, due to alcohol consumption, etc. HbA1c ~9.4% (NGSP).
Reason for admission: Poor blood glucose control.
Medication: Insulin injection before meals, before going to bed, self-check blood sugar before breakfast.
Diet therapy: Meals are supposed to be within 2000 kcal/day.
Patient states that his wife manages his diet at home, and that he does not care too much.
Patient eats cafeteria lunch of meat and deep-fried foods.
Patient snacks on sweet bread before going home. Work ends late at night and usually eats supper after 10 pm.
Average dietary intake: ~2500 kcal/day.
He smokes about 10 cigarettes and consumes 400 - 600 mL of alcohol daily.
Recent blood parameters: fasting blood glucose, 189 mg/dL; HbA1c, 9.1%.
Present medical status: Patient was hospitalized for about two weeks six years ago when insulin therapy was started. He stated that after discharge, he complied with diet therapy for about two months, but was busy with work and soon returned to his original lifestyle.
He is also aware that tobacco and alcohol are bad for diabetes, but he stated that to quit is worse as he needs them to work.
He talks about difficulties living with diet therapy and stated that he knows that therapy is good for his health, but he is unable to comply with everything that the doctor and nutritionist want him to do. This is because there are too many things involved.