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Harold’s Heartache

Mini Case Study #1: Harold’s Heartache
Harold is 46 and recently divorced. Since he and his wife separated, he noticed that he has been putting on some extra pounds, and his weight has climbed from 185 to 205 lbs (height is 5’11”) within the past 9 months. He’s been stressed with the divorce settlement and has started smoking again. Both of Harold’s parents had heart disease and he’s been on hypertension medications for 5 years. When he went to see his doctor, his blood pressure was143/85 mmHg and a lipid panel revealed that his total cholesterol is 260 mg/dL with an LDL level of 167 mg/dL and an HDL level of 35 mg/dL. He shared with his doctor that he used to exercise regularly, but had been physically inactive for over 6 months.

1) What factors put Harold at risk for heart disease? Discuss which are modifiable and which are not.

2) What is Harold’s risk of developing heart disease? Please show your work for any calculations.

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3) Discuss Harold’s cholesterol levels and ratio and compare them to recommendations.

4) What dietary changes would you recommend for Harold? Would you recommend any specific diet plans? Why or why not?

5) How would you assess Harold’s readiness to change, and what might be some meaningful goals for him to work towards?

Mini Case Study #2: Donna’s Diabetes
For the past 2 or 3 years, Donna has always had fasting blood sugar levels in the 100-120 mg/dL range. When she presents in your clinic however, her fasting blood sugar is 137 and her hemoglobin A1c is 8.3%. Donna is 58 years old, does not have a history of diabetes, has a height of 5’4” and weighs 165 lbs and she is on medication for hypertension. She says she has tried to lose weight many times in the past and often has success, but she always gains it back. She reports that she eats a “fairly healthy” diet but just loves to bake and often indulges in sweets. She does not know much about diabetes, except that it requires you to give yourself shots—and she hates needles!

6) What can you tell Donna about her diabetes status? What lab values helped you to determine that, and what are the relevant cut-points?

7) If Donna’s hemoglobin A1c is 8.3%, what is her average blood sugar? How does that compare to her fasting blood sugar, and why is it different or similar?

8) Donna is so scared of needles that at any mention of diabetes, she immediately resists, saying, “Don’t expect me to give myself a shot.” What can you tell her about various diabetes treatments and the likelihood of her needing to give herself a shot?

9) Explain why Type 2 diabetes often shows up later in life and how it differs from Type 1 Diabetes. How do the treatments for the two diseases compare?

10) What lifestyle changes would you recommend for Donna? What dietary recommendations would you make? Explain why you decided to focus on the behaviors that you did.

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