Drishti Thesis 1

“Role of Sustainable Plant Based Diet for the prevention
and treatment of Diabetes Mellitus”
Dissertation Submitted In
Partial fulfillment of requirement for the award of Degree of
Master of Science In
Clinical Nutrition & Dietetics
By
Drishti Bajaj
Guide
Dr. Kanchan Goswami
School of Biomedical Sciences GALGO-
TIAS UNIVERSITY UTTAR
PRADESH
April 2024
1
DECLARATION
I, hereby declare that the dissertation titled “ROLE OF SUSTAINABLE PLANT BASE
DIET FOR THE PREVENTION AND TREATMENT OF DIABETES MELLITUS” sub-
mitted herein has been carried out by me in the School of Biomedical Sciences of Galgo-
tias University Uttar Pradesh. The work is original and has not been submitted earlier as a
whole or in part for the award of any degree at this or any other Institution / University.
I also hereby assign to Galgotias University Uttar Pradesh all rights under copyrightthat-
mayexistinandtotheaboveworkandanyrevisedorexpandedderivativeswork sbased on the
work as mentioned. Other work copied from references, manuals etc. are disclaimed.
Drishti Bajaj
Date:
i
CERTIFICATE
The thesis titled “ROLE OF SUSTAINABLE PLANT BASE DIET FOR THE PREVEN-
TION AND TREATMENT OF DIABETES MELLITUS” submitted by Drishti Bajaj for
the award of degree of Master of Science in Clinical Nutrition & Dietetics, has been carried
out under my supervision at the School of Biomedical Sciences of Galgotias University Ut-
tar Pradesh. The work is comprehensive, complete and fit for evaluation.
Guide Division Chair
Dr. Kanchan Goswami
School of Biomedical Sciences School of Biomedical Sciences
Dean
External Examiner
3
APPROVAL SHEET
This thesis/dissertation/report entitled ROLE OF SUSTAINABLE PLANT BASE DIET

FOR THE PREVENTION AND TREATMENT OF DIABETES MELLITUS by Drishti
Bajaj is approved for the degree of M.Sc. clinical nutrition and dietetics .
Examiner
Supervisor
Date: 4 may 2024
Place:
4
STATEMENT OF THESIS PREPARATION
1. Thesis title: ROLE OF SUSTAINABLE PLANT BASE DIET FOR THE PREVENTION AND
TREATMENT OF DIABETES MELLITUS
2. Degree for which the thesis is submitted: M.Sc. clinical nutrition and dietetics
3. Thesis Guide was referred to for preparing the thesis.
4. Specification regarding thesis format have been closely followed.
5. The contents of the thesis have been organized based on the guidelines.
6. The thesis has been prepared without resorting to plagiarism.
7. All sources used have been cited appropriately.
8. The thesis has not been submitted elsewhere for a degree.
(Signature of the student)
Name: Drishti Bajaj
Roll No.: 22SBBS2060006
2
TABLE OF CONTENTS
Page no.
Declaration i
Certificate ii
Approval sheet iii
Statement of thesis preparation iv
Table of Contents v-vi
List of Tables vii-viii
List of Figures ix-x
Abstract v xi
CHAPTER1: INTRODUCTION 9-18
CHAPTER 2: REVIEW OF LITERATURE CHAP-
TER 3: MATERIALS AND METHODS
1. POPULATION AND SAMPLE
2. DATA COLLECTION
3. LITERATURE REVIEW
4. STUDY DESIGN
5. DATA COLLECTION METHODS
6. STATISTICAL ANALYSIS PLAN
7. ETHICAL CONSIDERATIONS
CHAPTER 4: RESULT
CHAPTER 5: CONCLUSION
REFERENCE
3
LIST OF TABLES
Table 1: diagnostic tests of renal calculi and T2DM
Table 2: medication: prescribed
Table 3: diet prescribed for renal calculi and T2DM
Table 4: diagnostic tests of LRTI and T2DM
Table 5: medication prescribed
Table 6: diet prescribed for LRTI and T2DM
Table 7: diagnostic test for urosepsis and T2DM
Table 8: medication prescribed
Table 9: diet prescribed for urosepsis and T2DM
Table 10: diagnostic tests for acute hypertension and T2DM
Table 11:medication prescribed
Table 12: diet prescribed for acute hypertension and T2DM
Table 13: diagnostic tests for ascites and cellulitis with T2DM
Table 15: diet prescribed for ascites and cellulitis with T2DM
Table 16: diagnostic tests for acute febrile illness and T2DM
Table 18: diet prescribed for acute febrile illness and T2DM
Table 19: diagnostic tests for AFI and T2DM
Table 21:diet prescribed for AFI and T2DM
Table 22: diagnostic tests for age and t2dm
Table 24:diet prescribed for age and t2dm
Table 25: diagnostic tests for acute stroke and T2DM
Table27: diet prescribed for acute stroke and T2DM
4
Table 28: diagnostic tests for urinary tract infection and T2DM
Table 30: diet prescribed for urinary tract infection and T2DM
Table 31: diagnostic tests for CAD and T2DM
Table 34: diet prescribed for CAD and T2DM
Table 35: diagnostic tests for osteoporosis and T2DM
Table 37: diet prescribed for osteoporosis and T2DM
Table 38: diagnostic tests for anemia and T2DM
Table 40: diet prescribed for anemia and T2DM
Table 41: diagnostic tests for DKA and T2DM
Table 43: diet prescribed for DKA and T2DM
Table 44: diagnostic tests for fatty liver and T2DM
Table 46: diet prescribed for fatty liver and T2DM
Table 47: diagnostic tests for CKD and T2DM
Table 49: diet prescribed for CKD and T2DM
5
LIST OF FIGURES
Figure 1: Estimate of Individuals with Diabetes Mellitus
Figure 2:Carbon Footprint of various UK diets, in pounds of CO2 Eq/day

Figure 3: Green House Gas emission by protein Source
Figure 4: Plant based diets and Diabetes Mellitus
ABSTRACT
6
The global burden of morbidity and death from food-related chronic illnesses is rising, owing to poor diet
quality and calorie overconsumption. Diabetes is a major reason for death, contributing to 1.6 million
deaths worldwide in 2015. The incidence of diabetes risen worldwide from 4.7% to 8.5% between 1980
and 2014, with low- and middle- income countries experiencing the greatest increase.Consistent evidence
from studies demonstrated that a diet heavy in plant-based foods (such as fruits, veggies, legumes, seeds,
nuts, and whole grains) and low in animal-based foods, especially red meat, was beneficial for health, in
addition to being lower in total energy, is both healthier and associated with a lower environmental im-
pact. It has been suggested that adopting a plant-based diet would lower your chance of developing type 2
diabetes (T2D). Planning, label reading, and self-discipline are required for a wholesome, plant-based
diet. The main advantages for patients who choose to adopt a plant-based diet include the potential to use
fewer drugs to manage a number of chronic illnesses, to lose weight, to reduce their chance of developing
cancer, and to lessen their risk of death from ischemic heart disease. A plant-based diet that contains a
reasonable number of fruits and vegetables and little low-fat animal products will be beneficial for a pa-
tient with obesity and diabetes. In comparison to non-plant-based diets, there is at least moderate-quality
evidence from the literature indicating eating a plant-based diet can result in considerable weight reduc-
tion, a lower risk of cardiovascular disease, and a longer lifespan. These findings imply that adopting a
plant-based diet may be an efficient way to both prevent and treat chronic illnesses.
Keywords: diabetes,Chronic disease, Plant base diet ,obesity, weight reduction, non - Plant base
diet
7
CHAPTER-1
INTRODUCTION
TITLE- ROLE OF SUSTAINABLE PLANT BASED DIET

FOR PREVENTION AND TREATMENT OF DIABETES MELLITUS
A series of metabolic illnesses known as diabetes mellitus are characterised by persistent hyper-
glycemia brought on by deficiencies in insulin production, insulin action, or both. The importance of in-
sulin as an anabolic hormone result in abnormalities in the metabolism of carbs, lipids, and proteins. Dia-
betes mellitus (DM), the most common endocrine disease, affects more than 100 million people world-
wide (Six % of the population). It has been discovered to harm several human systems, notably blood
vessels, eyes, kidneys, the heart, and nerves. The two kinds of diabetes mellitus—insulin dependent dia-
betes mellitus (IDDM, Type I) and non-insulin dependent diabetes mellitus (NIDDM, Type II)—have
been identified. Type I diabetes is an autoimmune illness characterised by a local inflammatory reaction
in and around the islets, followed by selective death of insulin secreting cells, whereas Type II diabetes is
characterised by peripheral insulin resistance and decreased insulin production.
1.1 Estimate of individual with Diabetes Mellitus :

According to estimates, 366 million individuals had DM in 2011, and 552 million will have the
condition by 2030. The prevalence of type 2 diabetes is growing in all nations, with low- and middle-in-
come countries accounting for 80% of all cases.6million people died in 2011 as a result of DM. By 2030,
it is anticipated that 439 million individuals would have type 2 diabetes.
Diabetes is a potentially devastating disease that is becoming more and more common in low-
and middle-income nations like India. India is expected to have 69.9 million cases of diabetes
by 2025, the great majority of which would remain untreated.
8
Figure 1: Estimate of Individuals with Diabetes Mellitus
1.2 SYMPTOMS
Many people ignore diabetic symptoms since the condition progresses slowly. People do not view this as
a major issue since, in contrast to many other diseases, the effects of hyperglycemia take time to appear.
Diabetes symptoms such as polyuria, polydypsia, and polyphagia are frequent in both type 1 diabetes,
which has a quick onset of severe hyperglycemia, and type 2 diabetes, which has very high levels of hy-
perglycemia. Severe weight loss is only seen in type 1 diabetes or when type 2 diabetes goes undiscov-
ered for a longer period of time. Additional signs and symptoms of undiagnosed diabetes include unex-
plained weight loss, exhaustion, restlessness, and physical discomfort. Mild symptoms or ones that ap-
pear gradually may potentially go missed.
1.3 COMPLICATIONS
In unmanaged diabetes mellitus, persistent hyperglycemia can lead to a number of acute and long-term
problems. Diabetes mellitus is a main factor in cardiovascular disease (CVD), renal failure, amputa-
tion of the lower limb, and blindness. Hypoglycemia, diabetic- ketoacidosis, hyperglycemia with hy-
perosmolar state, and hyperglycemia with diabetic coma are examples of acute consequences.
Nephropathy, neuropathy, and retinopathy are examples of chronic microvascular problems, whereas
cerebrovascular disease, peripheral artery disease, and coronary artery disease are examples of
chronic macrovascular difficulties. An estimated 1.4 to 4.7% of middle- aged diabetics experience a CVD
incident each year.
1.4 DIAGNOSIS
9
Diabetes can be diagnosed using either the haemoglobin A1C criterion or plasma glucose concentration
(fasting or 2-hour plasma glucose).
· FPG (Fasting Plasma Glucose)
After an 8-hour overnight fast, a blood sample is collected. According to the ADA, fasting plasma glu-
cose (FPG) levels more than 126 mg/dL (7.0 mm/L) correspond with the diagnosis.
· Two-Hour Oral Glucose Tolerance Test (OGTT)
In this test, the plasma glucose level is measured before and two hours after consuming 75 g of glucose.
Diagnosis of diabetes occurs when a 2-hour sample's plasma glucose (PG) level is more than 200 mg/dL
(11.1 mmol/L).
· Hb (A1C) Glycated Haemoglobin
A blood glucose average for the past two to three months is provided by this test.
1.5 HISTORY
The American Association of Clinical Endocrinologists and the American College of En-
docrinology released their new recommendations in January 2018, and they recommend that a plant-
based diet be the best nutrition strategy for people with diabetes because it fosters wellbeing and im-
proves diabetes management. At least 25 research examining the link between meat consumption and the
risk of T2D have been published; the majority of these studies found a favourable correlation between
consumption of red meat and/or processed meat. Additionally, there is a clear link between total dietary
heme iron consumption and heme iron from red meat and the risk of T2D, and high serum ferritin levels
are linked to both insulin resistance and the risk of T2D.
10
CHAPTER-2
Review of literature
Conducting a literature review is an essential step in extracting relevant information from previous research
conducted by various scholars for the current topic. It fulfils the function of giving the researcher a better under-
standing of the procedures to be followed when carrying out the research. Hence, relevant research papers were
examined in light of the study's aims.
2.1 SUSTAINABLE PLANT-BASED DIET
A sustainable diet is one that has little impact on the environment, supports current and future
generations' access to food and nutrition, and promotes a healthy lifestyle. Diets based on plants are more
environmentally friendly and sustainable. Food production is the leading cause of biodiversity loss on a
global scale, accounting for 80% of deforestation, 70% of freshwater usage, and 30% of human-caused
greenhouse gas emissions.
Meat has been recognised as the food with the highest influence on GHG emissions and land us-
age.1000 kcal of lamb or beef production results in 14 and 10 kg of GHG emissions, compared to merely
1 and 3 kg for the same amount of lentils or tofu. The production of animal food uses more resources and
has a greater negative impact on the environment. Animal protein (meat and dairy) production typically
takes 11 times more fossil fuel energy than protein derived from grains. Several studies have found that
reducing meat consumption can reduce GHG emissions, as well as land, water, and energy use, while
also improving the quality of life. Plant-based goods are more efficient to produce, whether measured by
weight, per serving, per calorie, or even protein content. Tofu (soybeans) takes 74 times less land and
eight times less water to produce the same amount of protein as beef. Vegan and lacto-ovo vegetarian di-
ets have both been recognised being more ecologically friendly than meat-based diets.
11
FIGURE-3: Green House Gas emission by protein Source
"Plant-based" is a broad word that can apply to diets that are mostly composed of cereals, veg-
etables, legumes, fruits, nuts, seeds, and goods manufactured from them. Diets that are vegetarian forgo
meat. Vegan diets, which forgo all animal products, and lacto-ovo vegetarian diets, which include dairy
and eggs, are subsets of the vegetarian diet. Fruits and vegetables are abundant in fibre, antioxidants, and
other nutrients, and they have been shown to have a negative correlation with the risk of developing
chronic illnesses and death. Additionally, whole grains are a good source of dietary fibre and are rich in
advantageous bioactive substances. Coffee and tea, which contain antioxidants and a variety of other
bioactive chemicals, can also contribute to a healthy plant-based diet. However, plant-based diets do not
have to be vegetarian. A variety of plant-based diets, many of which incorporate meat in moderation,
may minimise the risk of chronic illness.When assessing overall plant-based dietary patterns, it is critical
to investigate the types of foods included because not all plant-based diets are healthy. Higher consump-
tion of sweetened drinks, refined grains, potatoes/fries, and sweets are all part of an unhealthy plant-
based diet. The prevalence of vegetarianism varies by country; however, it is commonly estimated to be
12
Figure 2: Carbon Footprint of various UK diets, in pounds of CO2 Eq/day
fewer than 10% of the population. Adult vegetarians make up at least twenty percent of the population
across India.
Vegetarians, particularly vegans, should eat a well-balanced diet and utilise fortified foods and/or
supplements on a regular basis. Specifically, calcium, iron, vitamin D, and vitamin B12 need to be taken
into consideration. When supplements are not taken and food options are restricted or self-imposed, defi-
ciencies may become worse.
2.2 ROLE OF PLANT-BASED DIETS FOR DIABETES PREVENTION AND

TREATMENT
Diabetes prevalence has risen in recent decades as a result of considerable dietary changes, in-
cluding decreased consumption of vegetables, fruits, and legumes and increasing consumption of animal-
derived and processed food items. However, Chronic illnesses linked to nutrition are usually avoidable by
following a healthy diet and lifestyle.A plant-based eating pattern is associated with a significantly
lower incidence of type 2 diabetes as when compared with a nonvegetarian diets, and there is solid evi-
dence supporting the use of a plant-based eating pattern in therapeutic practise for persons with type 2 di-
abetes. The American and Canadian Diabetes Associations both list vegetarian and vegan dietary pat-
terns as ones that have been found to enhance glycemic management, body weight, and cardiovascular
risk factors.
The American Association of Clinical Endocrinologists and the American College of En-
docrinology released their new recommendations in January 2018, and they recommend that a plant-
based diet be the best nutrition strategy for people with diabetes because it fosters wellbeing and im-
proves diabetes management. At least 25 research examining the link between meat consumption and the
risk of T2D have been published; the majority of these studies found a favourable correlation between
consumption of red meat and/or processed meat. Additionally, there is a clear link between total dietary
heme iron consumption and heme iron from red meat and the risk of T2D, and high serum ferritin levels
are linked to both insulin resistance and the risk of T2D.
Plant-based diets can improve psychological health, quality of life, HbA1c levels, maintain weight and there-
fore diabetes management.
13
® Fibre, antioxidants, and magnesium are all plentiful in plant-based diets, all of which have been
demonstrated to boost insulin sensitivity. Polyphenols, for example, are antioxidants that can de-
crease glucose absorption, promote insulin secretion, reduce hepatic glucose output, and increase
glucose uptake.
® Fibre, which is exclusively present in plant foods, affects postprandial glucose response and is digested
by intestinal bacteria to create short-chain fatty acids, which help increase glucose response, insulin sig-
nalling, and insulin sensitivity.
® Lastly, a diet rich in plant-based foods and low in animal products may have positive metabolic
benefits by encouraging changes in the gut bacteria ecology and reducing the formation of
trimethylamine N-oxide, a substance linked to insulin resistance. A plant-based diet has been
found to lower visceral fat and improve signs of oxidative stress better than a standard diet in
those with type 2 diabetes.
FIGURE-4: Plant based diets and Diabetes Mellitus
2.2.1 Potential Mechanisms through Which Plant-Based Dietary Habits Influence

Weight Control and Resistance to Insulin
Insulin sensitivity
The hallmarks of type 2 diabetes pathogenesis include insulin resistance and consequent decrease in beta-
cell function. Plant-based dietary patterns benefit diabetic patients by improving insulin sensitivity and
body weight. Insulin resistance is induced by fat build-up inside muscle and liver cells, which often oc-
curs several years before the diagnosis of type 2 diabetes. This fat build-up responds strongly to dietary
modifications. The findings show that low-fat, plant-based (particularly vegan) diets enhance glycemic
management due to their potential to lower lipid build-up in muscle and liver, as well as their impact on
body weight. Plant-based diets may also boost beta- cell function.
14
Weight management
A plant-based eating patterns may aid in reversing impaired beta cells and peripheral insulin resistance in
type 2 diabetic patients. The likelihood of CVD and all-cause mortality is increased in persons with type
2 diabetes who are overweight. Comparing vegetarians and vegans to non-vegetarians, vegetarians and
vegans have lower mean BMIs.Population studies have shown that an increase in meat intake causes a
gradual increase in body weight. A plant-based dietary regimen is an efficient weight control strategy in
addition to preventing weight gain.
2.2.2 Diabetes Macrovascular and Microvascular Complications: A Plant-Based

Eating Pattern.
CVD
Coronary heart disease, cerebrovascular disease, and peripheral arterial disease are the various forms of
CVD. A meta-analysis of nine randomised controlled trials in individuals with type 2 diabetes (N = 664)
comparing vegetarian therapies with control diets found substantial reductions in CVD risk variables
such as lipids, blood pressure, glycemic management, body weight, and abdominal obesity.
Chronic Kidney Disease

Diabetes accounts for 44% of all new instances of chronic kidney disease; 20-40% of diabetic individuals
have chronic kidney disease. A Western diet that emphasises eating a lot of red meat, fat, salt, and sugar
is a primary factor in the metabolic abnormalities that cause kidney disease to worsen. Numerous studies
have shown that individuals with diabetic nephropathy who follow a plant-based or reduced-red-meat
diet had lower urine albumin excretion.
Neuropathy
A 20-week randomised controlled study employing a low-fat, vegan regimen indicated enhanced nerve
function and pain reduction when compared to an untreated control group.
Diabetic retinopathy
A plant-based diet is useful in lowering diabetic retinopathy risk factors such as glycemia, blood pres -
15
sure, and lipids. Moreover, studies have shown that diets high in fruits, vegetables, and dietary fibre
are related with a lower risk of diabetic retinopathy.
2.3 MACRONUTRIENTS AND CURRENT RECOMMENDATIONS

According to the American Diabetes Association's 2017 "Standards of Medical Care in Diabetes," a
range of eating regimens, including the Mediterranean, DASH, and plant- based diets, are suitable for the
management of type 2 diabetes and pre-diabetes. These recommendations emphasise nutrient-dense,
high-fibre, low-glycemic load meals and advocate getting carbohydrates from legumes, whole grains,
fruits, vegetables, and dairy products. Additionally, it is advised that diabetics adhere to the general popu-
lation's recommendations for trans-fat, dietary cholesterol, and saturated fat consumption. These recom-
mendations are compatible with plant-based diets. Vegetarian and vegan diets, according to the Academy
of Nutrition and Dietetics, are suitable for all ages—from infancy to adulthood—and may help with the
prevention and treatment of diabetes, obesity, and coronary heart disease.
PROTEIN
Many plant-based protein sources, such as most legumes, offer the advantage of being genuinely low in
fat. Additionally, they include fibre and a variety of advantageous phytonutrients, both of which are ab-
sent in animal foods and the typical American diet. All main sources of animal protein, including pro-
cessed meat, red meat, eggs, dairy, poultry, and fish, showed a mortality advantage of plant protein over
animal protein.
FATS
The risk of acquiring diabetes is enhanced by saturated and trans fats; in addition, when saturated fats are
substituted for carbohydrates in the diet of diabetic patients, they are actually linked to an increased death
rate. Carbohydrates (mostly refined starches and simple sugars) and saturated fats were replaced with
monounsaturated and polyunsaturated fats, which reduced haemoglobin A1c and improved insulin resis-
tance; polyunsaturated fats were also shown to enhance insulin secretion.
CARBOHYDRATES
People who have type 2 diabetes or are at risk for developing it frequently hold the misconception that
they should stay away from meals high in carbohydrates. According to meta-analyses of cohort stud -
ies, refined low-fiber carbs can actually raise the risk of diabetes whereas whole grain and cereal fi -
16
bres have been shown to lower it. Furthermore, several studies have revealed that low-carb diets actu -
ally raise the risk of type 2 diabetes .
2.4 FOOD AND NUTRITIONAL COMPONENTS OF PLANT-BASED DIETS
A lower risk of getting diabetes has been linked to whole grains, particularly brown rice, whole-
grain bread, and whole-grain cereals. Certain fruits and vegetables, such as apples, blueberries, grapes,
particularly leafy greens have been related to decreased diabetes rates. Legumes have also been demon-
strated to improve insulin resistance and protect against metabolic syndrome, and higher nut consumption
has been linked to a decreased incidence of diabetes. Fibre from cereals seems to be highly preventative
for type 2 diabetes. Recent meta-analyses on meat intake and type 2 diabetes predict a risk of 1.13 to 1.19
for 100 g of total red meat consumed per day and a risk of 1.19 to 1.51 for every 50 g of processed meat
consumed per day.
In a senior population (aged 65 to 100) in Greece, a 5% increase in protein consumption from ani-
mal products and meat was associated with a 34% greater risk of type 2 diabetes, even after modifying
for age, gender, obesity, history of hypertension, hyperlipidemia, and other dietary habits. Protein from
plant sources, however, provided defence against diabetes.
The suggested vegan diet included vegetables, fruits, grains, and legumes and provided around 10% of
calories from fat, 15% from protein, and 75% from carbohydrates.
2.5 Plant based diet: Background and epidemiology
According to estimates, 366 million individuals had DM in 2011, and 552 million will Have
the condition by 2030. The prevalence of type 2 diabetes is growing in all nations, with low-
and middle-income countries accounting for 80% of all cases.6million people died in 2011 as
a result of DM. By 2030, it is anticipated that 439 million individuals would have type 2 diabetes.
Diabetes is a potentially devastating disease that is becoming more and more common in low-
and middle-income nations like India. India is expected to have 69.9 million cases of diabetes
by 2025, the great majority of which would remain untreated.
It analysed plant-based meal planning as an appropriate and successful method that educators may
employ to enhance diabetes management and lower the risk of complications. According to studies,
17
dietary adjustments that are efficient for lowering cardiac risk may also be beneficial for type 2
diabetes treatment. A low-fat, plant-based diet has been demonstrated to be very well tolerated by
patients and to help patients lose weight and improve their glycemic control.
2.6 Pathophysiology
T2DM is characterized by insulin resistance in peripheral tissues (muscle, fat, and liver) with progressive
β cell failure, ,especially manifest with defective insulin secretion in response to a glucose stimulus, in-
creased glucose production by the liver, and no markers of pancreatic autoimmunity . The progressive de-
cline in β cell function is more rapid in youths at 20-30% decline per year versus 7-11% decline per year
in adults, even with aggressive medical therapy.In three prospective cohorts discovered an inverse rela-
tionship between a plant-based diet overall and T2D incidence. An index that represented a healthful form
of a plant-based diet had a higher inverse correlation with T2D, whereas an index that represented an un-
healthy version of a plant-based diet had a positive association with T2D. This study backs with existing
advice to switch to diets high in nutritious plant foods and reduce consumption of unhealthier plant and
animal products.
2.7 OBJECTIVES OF THE STUDY
1. To study the symptomology of Diabetes Mellitus.

2. To review the published studies on plant-based diet interventions for diabetes.
3. To study the environmental benefits of significantly reducing or eliminating meat and dairy
products from one's diet.
4. To study the therapeutic benefits of plant-based diet for the treatment of diabetes.
2.8 RELEVANCE OF THE STUDY
The global burden of morbidity and death from food-related chronic illnesses is rising, owing to poor
diet quality and calorie overconsumption. Diabetes is a major reason for death, contributing to 1.6 mil-
lion deaths worldwide in 2015. The incidence of diabetes risen worldwide from 4.7% to 8.5% between
1980 and 2014, with low- and middle- income countries experiencing the greatest increase.
Consistent evidence from studies demonstrated that a diet heavy in plant-based foods (such as
fruits, veggies, legumes, seeds, nuts, and whole grains) and low in animal-based foods, especially red
meat, was beneficial for health, in addition to being lower in total energy, is both healthier and associ-
18
ated with a lower environmental impact. It has been suggested that adopting a plant-based diet would
lower your chance of developing type 2 diabetes (T2D). Planning, label reading, and self-discipline are
required for a wholesome, plant-based diet. The main advantages for patients who choose to adopt a
plant-based diet include the potential to use fewer drugs to manage a number of chronic illnesses, to lose
weight, to reduce their chance of developing cancer, and to lessen their risk of death from ischemic heart
disease.
A plant-based diet that contains a reasonable number of fruits and vegetables and little low-fat
animal products will be beneficial for a patient with obesity and diabetes. In comparison to non-plant-
based diets, there is at least moderate-quality evidence from the literature indicating eating a plant-based
diet can result in considerable weight reduction, a lower risk of cardiovascular disease, and a longer life-
span. These findings imply that adopting a plant-based diet may be an efficient way to both prevent and
treat chronic illnesses. Without dramatic adjustments, these systems will be unable to maintain future
populations, especially as climate change and population expansion endanger our environment and food
supplies. Interventions and policy changes that shift the world towards healthy plant-based dietary pat-
terns might be critical in guaranteeing future personal, population, and planetary health if extensively
adopted. Because the food system accounts for over a quarter of all greenhouse gas emissions, and poor
diets and obesity are among the leading causes of early death.
More research is needed to develop strategies to make plant-based meals the new normal for pa-
tients and staff. We cannot cure chronic diseases, but we may be able to avoid and control them by mod-
ifying our diet. We can enhance health outcomes via education and adherence monitoring. The future of
medical care is going to involve an evolution towards an approach in which illness prevention and treat-
ment focus not on a pill or surgical operation, but on another serving of vegetables and fruit.
1. Schiattarella, et.al. (2021) Studied that a healthy plant-based diet may help to delay the onset of
GDM. GDM is still a pregnancy problem that is impacted through both inflammatory and ge-
netic variables. An unbalanced redox state may operate as a trigger for altering insulin sensitiv-
ity, and a healthy dietary pattern, such as a plant-based one, may be an appropriate substitute for
increasing antioxidant component consumption. However, additional studies, particularly ran-
domised controlled trials, are needed to expand our understanding of the relationships between
nutrition and redox status.
2. Fresan & Sabate. (2019) studied that climate change and other environmental effects are signif-
icantly influenced by the collective food choices a civilization makes. There is widespread
agreement that a worldwide shift towards a more plant-based diet is critical for sustaining plane-
19
tary limits. Additionally, vegetarian meals seem to be good for both the health of the population
and the earth. Briefly stated, population-level patterns of vegetarianism can help resolve the ur-
gent diet-environment-health trilemma. However, further study in diverse situations is required
to optimise meat-free meals for optimal health and environmental impact advantages. Effective
policy suggestions will be based on a greater grasp of the cultural and socioeconomic circum-
stances.
3. Satija & Hu. (2018) studied that a plant-based diets, characterised by varied degrees of limits on
animal product consumption, have been linked to a decreased risk of cardiovascular disease as
well as a better cardiovascular risk profile. Additionally, there are a variety of biochemical ways
through which wholesome plant meals may exercise their potential cardioprotective benefits.
However, there has been considerable worry regarding the nutritional sufficiency of vegetarian
diets, particularly vegan diets, which fully omit all animal products.
4. Toumpanakis,et.al. (2018) stated that plant-based diets combined with educational interven-
tions can considerably enhance psychological health, quality of life, HbA1c levels, and weight,
and therefore diabetes treatment. Additionally, plant-based diets can help T2D patients with their
levels of triglycerides, total cholesterol, and LDL cholesterol as well as their diabetic neuro-
pathic pain. The link between psychological health, dietary patterns/behaviour, and
diabetes management needs to be further studied. Future research might examine the best strate-
gies to educate participants about nutrition and encourage them to adopt healthier eating habits.
5. Koloverou,et.al. (2016) indicated that the prevention of developing diabetes by a diet high in
fruits, vegetables, legumes, and grains. The uniqueness lies in the fact that the healthy eating
plan exclusively consisted of plant-based foods and excluded fish, dairy, and chicken, and that
the antidiabetic impact was only observed in middle-aged individuals, who are at a key age for
the onset of diabetes. Because food is a lifestyle component that people can learn to manage, this
study has an important public health message, emphasising the need of following a plant-based
pattern not just for diabetes prevention, but also for the primary prevention of a wide spectrum of
cardio-metabolic disorders.
6. Melina,et.al. (2016) founded that governmental organisations and numerous health and nutrition
organisations are promoting the regular use of plant foods, which has caused awareness in and
enthusiasm for plant-based diets to increase in the US and other countries across the world. A
plant-based diet is easier to follow because there are many options available in the market. Vege-
tarian diets that are well-planned offer sufficient nutritional intakes for all stages of life and can
also be beneficial in the therapeutic treatment of some chronic conditions.
20
7. Satija,et.al. (2016) In three prospective cohorts discovered an inverse relationship between a
plant-based diet overall and T2D incidence. An index that represented a healthful form of a
plant-based diet had a higher inverse correlation with T2D, whereas an index that represented an
unhealthy version of a plant-based diet had a positive association with T2D. This study backs
with existing advice to switch to diets high in nutritious plant foods and reduce consumption of
unhealthier plant and animal products.
8. Yokoyama,et.al. (2014) have founded that vegetarian diets are linked to better glycemic man-
agement in type 2 diabetes patients.
9. Yokoyama,et.al. (2014) studied that vegetarian diet consumption is linked to decreased blood
pressure. To determine which sorts of vegetarian diets are most strongly linked to decreased BP,
more research is necessary. It would also be highly beneficial to do research on the use of such
diets in clinical settings or as part of public health efforts aimed at preventing hypertension.
10. InterAct Consortium. (2013) prospective investigation reveals a link between high total and red
meat intake and occurrence type 2 diabetes in a large group of European people.
11. Tonstad,et.al. (2013) have founded that vegetarian diets (vegan, lacto ovo, semi-) have been
linked to a significant and independent decrease in diabetes incidence. The level of protection
brought about by vegetarian meals was comparable to the elevated risk brought about by Black
ethnicity in Blacks.
12. Kahleova,et.al. (2011) founded comparison to a traditional diabetic diet over the course of 24
weeks, a calorie-restricted vegetarian diet exhibited a stronger ability to enhance insulin sensitiv-
ity. The reduced insulin resistance with this diet may be attributable to the enhanced reduction of
visceral fat and improvements in adipokine and oxidative stress marker plasma concentrations.
The addition of fitness training boosted the benefits of the vegetarian diet even further.
13. Carter,et.al.(2010) studied that increasing regular consumption of green leafy vegetables might
dramatically lower the risk of type 2 diabetes and needs to be researched more.
14. Wannamethee,et.al. (2009) discovered that dietary fibre is related with a lower incidence of di-
abetes, which can be explained in part by inflammatory indicators and hepatic fat deposition.
15. Almeida,et.al. (2008) studied that the presence of microalbuminuria was linked to a high protein
consumption and a low intake of PUFAs, mainly from plant oils, in type 2 diabetes individuals.
Microalbuminuria risk may be decreased by consuming less protein from animal sources and
more fats from plant sources.
21
CHAPTER- 3
MATERIAL AND METHODS
3.1 POPULATION AND SAMPLE

The population under study will consist of patients diagnosed with Type 2 diabetes mellitus
(T2DM) with other diseases. There are 15 case studies . Inclusion criteria for the case study in-
clude individuals diagnosed with Type 2 diabetes with other disease , both male and female. The
study will be conducted over a duration of 4 months in a hospital setting.
Visited the fortis hospital and worked as a dietetic intern
Encounter and examined patients with disorders
Conducted fifteen case studies on patients suffering from T2DM and its associated complications
Carry out a clinical and nutritional assessment
22
Subject profile
Medical assessment
Nutritional assessment
Nutritional interventions
Diet prescribed: Foods to be included and avoided
Outcome
23
CHAPTER-4
RESULT
4.1 CASE STUDY-1: Diabetes Mellitus and Renal Stone

SUBJECT PROFILE-
· NAME –ABC
· AGE – 43
· GENDER- Female
· MEDICAL CARE- In patient
· ACTIVITY –Sedentary
· ALLERGIES: FOOD- Not Known
DRUG- Not Known
MEDICAL ASSESSMENT
· PRESENT MEDICAL CONDITION- Pain in Left upper abdomen, generalized weakness,
nausea (3 days)
· PAST MEDICAL CONDITION- Diabetic since past 5 years, RBS-456 mg/dl, tiredness noted,
UTI
24
· FAMILY HISTORY- NIL
· DIAGNOSIS-Renal stone with hyperglycaemia
· COVID-19 VACCINATION STATUS-Taken both doses
NUTRITIONAL ASSESSMENT DIAGNOSTIC

TEST-
® Blood Pressure- 130/80 mm/hg
® Pulse – 88 per min
® Sp02- 98%
S.N PARAMETERS TEST RESULT NORMAL RANGE

O
1 RBS 456 70-140 mg/dl
HBA1c 9.8 <5.7%
2 Haemoglobin 9.13 12.0-15.0 g/dl
3 S 134.7 135-148 mmol/L
o 5.47 3.50-5.30 mmol/L
d 9.40 8.8-10.2 mg/dl
i
u
m
P
o
t
a
s
s
i
u
m
Cal-
cium
4 Urea 8.4 16.6-48.5 mg/dL
Creatinine 0.48 0.50-0.90 mg/dl
5 Albumin 4.0 3.5-5.0 g/dl
6 25-hydroxy vitamin D 7.85 20 and 40 ng/mL
Table-2 Diagnostic tests of Renal calculi and T2DM
*USG- calculus of 25 mm in the calyx of Right kidney
25
-Co-morbid Disease
Dia- Y Hyperten- X Heart Prob- X Kidney Disor- ye

betes es sion lems der s
-Eating Habits
Vegetarian Yes Eggetarian X Non-Vegetarian X

(NONG)
FOOD INTAKE AND NUTRITION RELATED HISTORY

She was consuming 3 meals per day that were not relevant to her medical condition.
· Breakfast – Tea 1 cup (150 ml), biscuit (2), Sabzi + roti (1)
· Lunch- Roti (2), Sabzi 1 Katori, curd
· Dinner-Roti (2), dal/Sabzi 1 Katori
A lack of overall dietary intake of food was observed.

Physically Active- Earlier the patient was able to perform her daily routine activities and also used to go
for walk in the morning, but due to weakness the movement was only from her bed to the bathroom.
Medication Name Dose

Vitamin D2 weekly
Metformin 500mg Twice a day
Calcium Supplement Once daily
TABLE-3: Medication Prescribed
NUTRITIONAL INTERVENTIONS
Based on the diagnosis and partake of food, dietary modifications were planned for the patient, before
planning the diet an interaction was done with the patient to know about her food choices, likes and dis-
likes, food availability, cooking pattern and the size of glass, bowls and other utensils were also deter-
mined.
Fruit, soup, coconut water, green leafy vegetables, and fruits were restricted as the potassium levels
were high, the patient was given a potassium restricted diet till normal levels were achieved. Vitamin
D2 and B12 supplements were given.
GOALS-
26
1-To maintain health of Diabetic patient
2-To maintain normal Blood sugar levels.
3.To provide adequate nutrition and protect the individual against infection 4- To increase
Fluid intake for adequate hydration
DIET PRESCRIBED- Diabetic Soft Diet (oxalate free and low potassium diet) was Prescribed
TABLE-4: Diet prescribed for Renal calculi and T2DM
MEAL MENU MEASURE

Earl -Tea/ fennel water (Without Sugar) 1 Cup (60 ml)
y -Nuts Or Biscuits
Mor (Marie/ Oats/ Digestive / High 2
ning Fiber Biscuits)
(6:00
-7:00
AM)
Breakfast -Cereal: (Daliya Por- 1 medium bowl
(8:00-9:00 AM) ridge/ Oats/ Wheat
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
-Brown Bread Sandwich 1 Glass (200 ml)
with paneer / Idli
-Toned Milk 1 small
-Protein:(Besan 40 gm
cheela/Moong dal
Cheela/
Paneer)
Mid-Morning Fruit: Apple/Papaya (100 gm)
(11:00-12:00 PM)
Lunch -Cereal: Soft Chapatti/ 2
(1:00- Khichdi/ 1 medium bowl
1:30 PM) Dalia Rice 1 medium
boiled bowl (twice
a week)
-Vegetable: Seasonal Vegetable 1 medium Ka-
(low potassium) tori
-Dal: Whole Dal, Soya Preparation
or Paneer 1 medium Ka-
27
tori
1 small Katori
-Curd: Fresh Curd/Vegetable 1 glass (200)

Raita/buttermilk (plain)
Evening Tea -Tea or herbal tea (without Sugar) 1 Cup (60 ml)
(4:00-4:30 PM) -Non-Fried Snack 1 small bowl
Pre- -Buttermilk (plain unsalted) 1 Cup (200 ml)
din-
ner
(5:3
0-
6:00
PM)
Dinner -Cereal: Soft Chap- 2 medium size
(7:00-8:00 PM) atti (With 1 Medium Ka-
Bran)/ Dalia tori
-Vegetable: Seasonal 1 Medium Ka-
Vegetable (low potas- tori
sium)
-Dal: Whole Dal, Soya 1 Medium Ka-
Preparation or Paneer tori
-Curd: Fresh Curd
(Toned Milk) 1 Small Katori
- Dessert (sabot Optional- 1
dana kheer without small bowl
sugar)
Bedtime Milk (Toned Milk) 1 Cup (200ml)
(½ hour before
sleep)
*Oil- 2 tbsp * Sugar- Avoid or limit * salt-½ tsp/day *Fluid intake –2200 ml/day
IMPORTANT INSTRUCTIONS AND DIETARY TIPS -
· Never skip meals. Eat meals and snacks at the same times every day to prevent high blood sugar
levels. Maintain a consistent daily intake so that the medication regimen matches the food intake.
· Monitor carbohydrate consumption carefully since the quantity of carbohydrate consumed, the
time it is eaten, and what it is paired with all influence blood sugar levels.
· Watch your blood sugar levels on a regular basis.
· Oil should be replaced every three months.
28
· Cook with iron cookware.
· Fasting and feasting should be avoided by the patient.
· Take only the recommended amount of vegetables and pulses.
Group A consists of olive oil, canola oil, and rice bran oil.
Group B consists of refined oils, groundnut oils, soybean oils, and mustard oils.
FOOD INCLUDED-
· A lot of fibre-rich foods (salads, sprouts, vegetables, fruits, brown bread, ragi, oats, barley).
· When feeling hungry, consume low in calories items like salads, clear soups, tomato juice,
lemon water, sprouts, plain buttermilk, bhuna Channa.
· Toned, double-toned, Almond milk in place of full cream milk.
· Consume salad and boiled vegetables such as radish, cucumber, green leafy vegetables, cab-
bage, spinach, bottle gourd, and bitter gourd.
· Lemon water, a thin, sugar-free lassi, and vegetable soup.
· Vegetables such as Ghia, tori, tinda, pumpkin, beans, carrot, capsicum, zucchini and others are
recommended.
· Fruits such as Apricot, Plum, apple, papaya, Jamun, Pineapple, Guava
· It is suggested to eat pulses like moong, masoor, and arhar.
· Protein-rich foods include tofu, paneer, low fat milk and its derivatives, and lentils.
· Eat adequate calcium-rich plant-based foods, such as juices with added calcium.
FOOD AVOIDED-
· High-salinity foods (processed meals, canned goods, market butter, ketchup, sauces).
· Excessive protein consumption can be decreased by avoiding red meat and processed meat.
· Sugar and related items
· juices from fruits, milkshakes, carbonated beverages, desi ghee, and butter
· Vegetables like roots and tubers e.g., potato, Arbi, sweet potato, yam, beetroot
· Fruits with main meals should be had in between meals; mango, banana, Cheeku, Custard
apple, grapes, litchi, and sweet melon should be avoided.
· If you have a high blood sugar, avoid fruit juices (fresh or tetra pack).
· Brown rice is preferred over white rice.
· Don’t consume ketchup,jam,jelly,ajinomotto,packaged juices, canned items and salted butter,
cheese.
· Avoid eating spicy, oily, fried, or outdoor meals.
· Sauces, pickles, Papads (cooked in oil), and parathas, poories, pakoras, namkeens, mathris,
29
and deep-fried veggies are not recommended.
The sources include:
® PHOSPHATE: rajma, soya, marine foods, almonds, carrots
® OXALATE-containing foods include coffee, cocoa, spinach, amla, sweet potatoes, choco-
lates, lotus stems, beetroot roots and mustard leaves.
® PURINE: Mutton, organ meat, rajma, oats, beans, spinach, mushroom, Gobi
® CALCIUM: Green leafy vegetables, mutton, milk and products, cheese, egg yolk, oats, dry nuts,
seeded vegetables
IN CASE OF HYPOGLYCEMIA
Snacks to prevent severe hypoglycemia, have a night-time snack comprising protein, starch, and con-
sume to supply the body with an energy source that will persist throughout the night.
Pick any of the following to raise blood sugar:

· Glucon d powder
· Glucose biscuits
· Sugar candies
POTASSIUM:
1. If the potassium levels exceed 4.8, then:
· Citrus fruits, juices, coconut water, raw vegetables, salads, amla, lemon, soups, pudina chutney,
and sauces are not permitted.
· All vegetables should be boiled before being consumed.
· Cooking should use less salt.
2. If the potassium reading is between 3.5 and 4.8,
· Apple, papaya, guava, and pineapple are all limited to 100 grams of each. No additional fruits
· No sauces, citrus juices, coconut water, raw vegetables, salads, amla, raw mango chutney,
tomato chutney, or sauces.
· Preparation with tomatoes should be minimal.
30
4.2 CASE STUDY- 2
(Diabetes mellitus and LRTI)
SUBJECT PROFILE-
· NAME –XYZ
· AGE – 61
· GENDER- Female
· MEDICAL CARE- In patient
· ACTIVITY –Sedentary
· ALLERGIES: FOOD- Not Known
DRUG- Not Known
MEDICAL ASSESSMENT
· PRESENT MEDICAL CONDITION- Dyspnoea (5-6 days), Fever (2-3 days), cough (pink
sputum), Generalised weakness, Generalised swelling (2-3 days).
· PAST MEDICAL CONDITION- Diabetic type-2 from past 10 years, Hypertension x 3
months, Hypothyroidism since last 5-6 years
· FAMILY HISTORY- NIL
· DIAGNOSIS- LRTI/Respiratory Failure/Pulmonary Edema/AKI
· COVID-19 VACCINATION STATUS-Taken both doses

TEST-
Vitals monitoring was advised
® TEMP-97 F
® Sp02- 96%
S.N PARAMETERS TEST RESULT NORMAL RANGE

O
1 RBS 477 70-140 mg/dl
HBA1c 10.2 <5.7%
3 S 123 135-148 mmol/L
o 4.98 3.50-5.30 mmol/L
d 8.74 8.8-10.2 mg/dl
i
31
u
m
P
o
t
a
s
s
i
u
m
Cal-
cium
4 U 80.9 16.6-48.5 mg/dL
r 1.20 0.50-0.90 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 3.6 3.5-5.0 g/dl
Table-5: Diagnostic tests of LRTI and T2DM
*Ultrasound – Gallbladder shows a calculus of 25 mm.
Co-morbid Disease-
Dia- Ye Hyperten- Ye Heart Prob- X Kidney Ye

betes s sion s lems Disorder s
Eating Habits-
Vegetarian Yes Eggetarian Yes Non-Vegetarian Yes
32
She was eating three meals a day, and certain dietary changes were made to hasten her recuperation. The
overall water consumption was low, and it was clear that the patient ate a lot of spicy and fried items.
The patient also had a bad habit of salting her food excessively.
· breakfast: two biscuits, tea, and one 250 ml glass of milk

· Lunch: rice, 2 rotis, and 1 bowl of sabzi
Tab Mucinac 600 mg Twice a day
Iron Supplement Weekly
Dinner: 2 Rotis, 1 bowl of dal, and 1 Katori of rice Physically Active- The patient was not physically ac-
tive. DRUG PRESCRIBED-
TABLE-6: Medication Prescribed
mined.
As the Sodium levels were low the patient was given extra salt till normal range were achieved.
GOALS-
1. To provide Adequate Nutrition
2. To maintain healthy body weight and improved Respiratory function 3-To maintain
good nutritional status
4. To maintain normal Blood sugar levels
DIET PRESCRIBED- A Diabetic Soft Diet with Extra salt was Prescribed.
Table-7: Diet prescribed for Lower respiratory tract infection and T2DM
M MENU MEA-
33
E SURE
A
L
Early -Tea Without Sugar 1 Cup
Morni -Nuts Or Biscuits 2
ng (Marie/ Oats/ Digestive / High
(6:00- Fiber Biscuits)
7:00
AM)
Breakfast -Cereal: (Daliya Porridge/ Oats/ 1 medium
(8:00-9:00 AM) Wheat Flakes /Vegetable Poha/ bowl
Vegetable Upma)
-Brown Bread Sandwich with pa- 2

neer / Idli 1 Glass (200
Toned Milk ml)
-Protein:(Besan cheela/ 1 small

Moong dal Cheela/ 40 gm
Paneer)
Mid-Morning Fruit: Apple/Guava/Papaya/ Pear (100-150gm)

(11:00-12:00 PM)
Lunch - 2
(1:00-1:30 C 1 medium
PM) e- bowl
r
e 1
al mediu
: m Ka-
S tori
o 200 gm
ft
C 1
h mediu
a- m Ka-
p tori
at
ti
/
K
hi
c
h
di
34
/
D
al
ia
-Veg-
-Dal: Whole
Dal, Soya
Preparation or
Paneer
Evening Tea -Tea or herbal tea (without Sugar) 1 Cup
(4:00-4:30 PM) -Non-Fried Snack (sprouts, fruit salad)/ 1 small bowl

-Boiled soya bean chat 1 bowl
Pre- -Soup 1 bowl
din-
ner
(5:30-
6:00
PM)
Dinner -Cereal: Soft Chapatti 2 medium Size
(7:00-8:00 PM) (With Bran)/ Dalia 1
-Vegetable: Seasonal Mediu
Vegetable m Ka-
Salad tori
1
-Dal: Whole Dal, Soya Mediu
Preparation or Paneer m Ka-
- Dessert (sabot dana tori 200
kheer without sugar) gm
1
Mediu
m Ka-
tori
Op-
tional- 1
small
bowl
Bedtime Milk + a pinch of turmeric (Toned 1 Cup (200ml)
35
(½ hour before Milk)
sleep)
*Oil- 2 tbsp * Sugar- Avoid or limit * salt-2gm/day *Fluid intake –1500ml/day

• Never skip meals. Eat meals and snacks at the same times every day to prevent high blood sugar
• Monitor carbohydrate consumption carefully since the quantity of carbohydrate consumed, the
• Watch your blood sugar levels on a regular basis.
• Fasting and feasting should be avoided by the patient.
• Oil should be replaced every three months.
• Cook with iron cookware.
• Vitamin C aids in iron absorption by the body; juices and salads aid in iron absorption.
• Take only the recommended amount of vegetables and pulses.
• Regular exercise for 30 minutes each day is recommended.
• Artificial sweeteners should not be consumed.
• Cereals can be supplemented with pulses
• While eating, maintain a straight posture.
• Take a break in between meals and practise deep breathing exercises.
• Consume four to six small meals per day. Your diaphragm may move freely as a result, which
makes it simpler for your lungs to take in air and expel it.
FOOD INCLUDED-
• 4 to 6 small, regular meals.
• A lot of fibre-rich foods (salads, sprouts, vegetables, fruits, brown bread, oats).
• When feeling hungry, consume low in calories items like salads, clear soups, sprouts, bhuna
Channa.
• Toned, double-toned, Almond milk in place of full cream milk.
• Consume salad and boiled vegetables such as radish, cucumber, green leafy vegetables, broc-
coli, spinach, bottle gourd, and bitter gourd.
• A thin, sugar-free lassi, and vegetable soup.
• Vegetables such as Ghia, tori, tinda, pumpkin, beans, carrot and others are recommended.
• It is suggested to eat pulses like moong, masoor, and arhar.
• Include Vitamin C sources-GLVS,lime water, Tomato soup etc.
36
FOOD AVOIDED-
• High-salinity foods (processed meals, canned goods, market butter, ketchup, sauces).
• Excessive protein consumption can be decreased by avoiding red meat and processed meat.
• Sugar and related items
• Juices from fruits, milkshakes, carbonated beverages, desi ghee, and butter
• Vegetables like roots and tubers e.g., potato, Arbi, sweet potato, yam, beetroot
• Fruits with main meals should be had in between meals; mango, banana, Cheeku, Custard
• If you have a high blood sugar, avoid fruit juices (fresh or tetra pack).
• Brown rice is preferred over white rice.
• Don’t consume ketchup,jam,jelly,ajinomotto,packaged juices, canned items and salted butter,
cheese.
• Avoid eating spicy, oily, fried, or outdoor meals.
• Sauces, pickles, Papads (cooked in oil), and parathas, poories, pakoras, namkeens, mathris,
OUTCOME- The patient was conscious minded in a stable state following the dietary modifications.
Blood sugar levels regulated. From 123.6 to 134.2 mmol/L of sodium and 80.9 to 37.82 mmol/L of urea
Each vital sign is stabilised. Breathing improved.
37
4.3 CASE STUDY-3
(Diabetes mellitus and Urosepsis)
SUBJECT PROFILE-
• NAME –AXX
• AGE – 72
• GENDER- Female
• MEDICAL CARE- In patient
• ACTIVITY –Sedentary
• ALLERGIES: FOOD- Not Known
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Fever with successive stages of chills (3 days), Body
ache, Nausea, Low appetite, Loose stool (1 day)
• PAST MEDICAL CONDITION- Diabetic type-2 from past 15 years
• FAMILY HISTORY- Not Applicable
• DIAGNOSIS-Urosepsis
• COVID-19 VACCINATION STATUS-Taken both doses

TEST-
® Blood Pressure- 100/60mm/hg
® Sp02- 88%
S.N PARAMETERS TEST RESULT NORMAL

O RANGE
1 RBS 195 70-140 mg/dl
HBA1c 6.8 <5.7%
38
3 S 125.3 135-148 mmol/L
o 5.10 3.50-5.30
d 8.70 mmol/L
i 8.8-10.2 mg/dl
u
m
P
o
t
a
s
s
i
u
m
Cal-
cium
4 Urea 109.5 16.6-48.5 mg/dL
Creati- 4.73 0.50-0.90
nine 51.18 mg/dl 8-
BUN 23mg/dl
5 Albumin 3.1 3.5-5.0 g/dl
6 C-Reactive Protein CRP 422.62 <5.0 mg/L
7 Uri
ne
Rou 6.5 5-6
tine 60-70 0.0-5.0 /HPF
and 12-15 Nil /HPF
Mi-
cros
cop
y
PH
W
hi
te
bl
o
o
d
c
el
ls
39
R
e
d
bl
o
o
d
c
el
ls
8 Procalcitonin Level 88.71 Undetectable or
<0.5 ng/dl
Table-8: Diagnostic test for Urosepsis and T2DM Co-morbid Dis-

ease-
Dia- Y Hyperten- X Heart Prob- X Kidney Yes

betes es sion lems Disorder
Eating Habits-
Vegetarian Yes Eggetarian X Non-Vegetarian Ye

s

She was eating four meals a day that were unrelated to her medical condition. Certain dietary changes
were made in his diet to aid the patient's rehabilitation.
▪ Tea one cup (60) with rusk for breakfast

▪ Mid-morning: Fruit juice, lassi, and namkeen (each serving is 250 ml).
▪ Lunch: 4 Rotis, 1 Katori of Sabzi, 1 Katori of curd, and desserts
▪ Dinner: 5 rotis, 2 Katori of dal or sabzi, 1 Katori of rice, 1 Katori of curd. Sugary dessert (1 Ka-
tori)
Following an examination of the patient's food history, it was discovered that she eats a heavy dinner,
missed meals in between and ate excessively at the next meal, and her protein, fat, and sugar intake was
not monitored.
Physically Active- She was not Physically active.
DRUG PRESCRIBED-
40
Meropenem 500mg Once daily
Vitamin C supplement Once daily
Table-9: Medication Prescribed

Based on the diagnosis and partake of food, dietary modifications were planned for the patient. Due to
the patient's extremely low albumin level, extra care was required to ensure proper protein absorption.
The patient was advised to consume a lot of protein. Five to six meals were supplied to the patient since
they were likewise not interested in eating. The patient was kept on a liquid diet and restricted from
milk, tea and papaya in the early days due to loose motions and vomiting. Curd was added to her diet.
She was then placed on a Diabetic Renal Soft Diet for some time since her kidneys were also infected.
And a low potassium diet was given.
GOALS-
1. To not harm the infected kidney

2. To prevent and delay other complications
3. To provide adequate nutrition and maintain blood sugar
DIET PRESCRIBED- Diabetic- Renal Soft Diet (low potassium) was Prescribed
TABLE-10: Diet prescribed for Urosepsis and T2DM
M M MEA-
E E SURE
A N
L U
Earl -Tea/Herbal tea Without Sugar 1 Cup
y -Biscuits 2
Mor (Marie/ Oats/ Digestive / High
(6:00
-7:00
AM)
41
Breakfast -Cereal: (Daliya Porridge/ Oats/ 1 medium bowl
(8:00-9:00 AM) Wheat Flakes /Vegetable Poha/
Vegetable Upma/Stuffed chap- 1
atti/veg sandwich)
-Brown Bread Sandwich with pa- 2

neer / Idli 1.Glass (200 ml)
Toned Milk
-Protein:(Besan cheela/ 2.small

Moong dal Cheela/ 50 gm
Paneer)
Mid-Morning Fruit: Apple (100 gm)

(11:00-12:00 PM)

boiled bowl (twice
a week)
(low Potassium) tori

tori
-Curd: Fresh Curd/Vegetable Raita
1 small Katori
Eve -Tea or herbal tea/coffee 1 Cup
ning -without Sugar 1 small bowl
Tea -Non-Fried Snack
(4:0
0-
4:30
PM)
Pre- -Soup (Dal/beans/mushroom soup) 1 bowl
din-
ner
(5:3
0-
6:00
PM)
42
Dinner -Cereal: Soft Chap- 2 medium Size
Bran)/ tori
Dalia, 1 Medium Ka-
Khichdi tori
-Vegetable: Seasonal
Vegetable (low Potas-
sium)
1 Medium Ka-
tori
-Dal: Whole Dal, Soya
Preparation or Paneer
1 Small Katori
-Curd: Fresh Curd Optional- 1
(Toned Milk) small bowl
- Dessert (sabot
dana kheer without
sugar)
Bedtime Milk with a pinch of turmeric 1 Cup (250ml)
(½ hour before (Toned Milk)
sleep)

• Monitor carbohydrate consumption carefully since the quantity of carbohydrate consumed,

the time it is eaten, and what it is paired with all influence blood sugar levels.
• Wash your hands frequently.
43
FOOD INCLUDED-
• A lot of fibre-rich foods (salads, sprouts, vegetables, fruits, brown bread, ragi, oats, barley).
• When feeling hungry, consume low in calories items like salads, clear soups, tomato juice,
lemon water, sprouts, plain buttermilk, Roasted makhana, bhuna Channa.
• Consume salad and boiled vegetables such as cucumber, green leafy vegetables, cabbage,
spinach, bottle gourd, and bitter gourd.
• Lemon water, a thin, sugar-free lassi, and vegetable soup.
• Vegetables such as Ghia, tori, tinda, pumpkin, beans, carrot, capsicum, zucchini and others are
recommended.
• Fruits such as Apricot, Plum, apple, papaya, Jamun, Pineapple, Guava
FOOD AVOIDED-
• Sugar and related items, avoid taking drinks high in caffeine.
• juices from fruits, milkshakes, carbonated beverages, desi ghee, and butter
• Vegetables like roots and tubers e.g., potato, Arbi, sweet potato, yam,beetroot
• canned juices etc.
• Don’t consume food items containing baking soda like bakery products
• Use of table salt is not advised.
OUTCOME-Vital signs were regularly monitored while the patient was stable. Recovery of the kidney
was observed. The patient was then put on a diabetic regular diet and the levels of blood sugar remained
under control. Better appetite, no longer experiencing nausea and lose motions. Albumin and potassium
levels back to normal.
44
4.4 CASE STUDY- 4(Diabetes mellitus and Acute Hypertension)
SUBJECT PROFILE-
• NAME –ABB
• AGE – 53
• GENDER- Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Severe Headache, Pain abdomen (burning sensation),

marked weakness, very less oral intake, giddiness, numbness
45
• PAST MEDICAL CONDITION- Diabetic type –2 from past 5 years.
• FAMILY HISTORY- Not applicable
• DIAGNOSIS-Acute hypertension

TEST-
® TEMP- 98 F
® Sp02-98 %

O RANGE
1 RBS 345 70-140 mg/dl
3 Sodium 137 135-148 mmol/L
Potas- 4.43 3.50-5.30
sium 9 mmol/L
Cal- 8.6-10.0 mg/dl
cium
4 U 23.2 16.6-48.5 mg/dL
r 0.70 0.70-1.20 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 4.3 3.5-5.0 g/dl
Table-11: Diagnostic tests for Acute hypertension and T2DM Co-morbid Dis-
ease-
46
Dia- Y Hyperten- Yes Heart X Kidney X
betes es sion Problems Disorder
Eating Habits-
The patient ate three meals a day and consumed a lot of animal products like red meat, processed meat, and
mutton. He was eating a lot of junk food and things that were very
salty and consumed butter, Ghee with each meal. He was eating too much salt and oily meals.
Physically Active- He walk for at least 10 mins in the corridor of the hospital.
DRUG PRESCRIBED-
Telma –H 100 mg Once daily
Ecosprin 75 mg Once daily
TABLE-12: Medication Prescribed NUTRITIONAL

INTERVENTIONS
Based on the diagnosis and partake of food, dietary modifications were planned for the patient. An overall re-
duction in salt intake was suggested.
GOALS-
1. To keep blood sugar and levels of blood pressure normal

2. To reduce sodium intake
3. To maintain a healthy body weight
DIET PRESCRIBED- Diabetic Salt Restricted Soft Diet was Prescribed
TABLE-13: Diet prescribed for acute hypertension and T2DM
M M MEA-
E E SURE
A N
L U
47
Earl -Tea Without Sugar 1 Cup
y -Nuts Or Biscuits 2
(6:00
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
with paneer / Idli
Toned Milk
1 small
cheela/Moong dal
Cheela/
Paneer)
(11:00-12:00 PM)
boiled bowl (twice
a week)
-Vegetable: Seasonal Veg- 1 medium Ka-
etable Salad tori
-Dal: Whole Dal, Soya Preparation 200 gm
-Curd: Fresh Curd/Vegetable Raita tori
1 small Katori
Eve -Tea without Sugar or herbal tea 1 Cup
ning -Non-Fried Snack (sprouts, 1 small bowl
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
48
din- -Buttermilk (plain unsalted) 1 glass (200 ml)
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
-Vegetable: Sea- 1 Medium Ka-
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d
1 Small Katori
-Dal: Whole Dal, Soya Optional- 1
Preparation or Paneer small bowl
-Curd: Fresh Curd
(Toned Milk)
- Dessert (sabot
dana kheer without
sugar)
(½ hour before
sleep)
*Oil- 2 tbsp * Sugar- Avoid or limit * salt-3gm/day *Fluid –3000ml/day
• Monitor Blood pressure regularly

• Instead of consuming 3 big meals, consume 6-7 little portions every two hours.
49
• Drink lots of water (10-13 glasses per day) but avoid consuming it with meals; a half-hour break
is recommended after and before meals.
• juice to each glass of milk (milk should be sugar-free).
• Using a combination of oils, reduce total fat and trans-fat consumption and reduce choles-
terol and saturated fat consumption.
FOOD INCLUDED-
• Consume salad and boiled vegetables such as radish, cucumber, green leafy vegetables, cab-
recommended.
• Protein-rich foods include tofu, paneer, low fat milk and its derivatives, and lentils.
• Include Fluids like-lime water, coconut water (150 ml), Buttermilk (plain unsalted without
sugar).
FOOD AVOIDED-
• Decrease or limit the consumption of animal products
• Juices from fruits, milkshakes, carbonated beverages, desi ghee, and butter
50
cheese.
OUTCOME-RBS was 345 mg/dl at admission, and it was 116 mg/dl upon discharge. The patient's state
became better. Blood pressure readings were normal.
4.5 CASE STUDY- 5

(Diabetes mellitus with Ascites and cellulitis complication) SUBJECT PROFILE-
• NAME –XYA
• AGE – 52
• GENDER- Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- pain abdomen, abdomen distended, restlessness, lack of
energy, fever with chills, vomiting, nausea, Multiple wounds over bilateral leg and feet
• PAST MEDICAL CONDITION- Diabetes type-2, hypertension
• FAMILY HISTORY- Not significant
• DIAGNOSIS-Ascites/splenomegaly/cellulitis

TEST-
® TEMP-102.1 F
® Sp02- 96%

O RANGE
51
1 RBS 147 70-140 mg/dl
HbA1c 14.5 <5.7%
3 S 126.5 135-148 mmol/L
o 4.53 3.50-5.30
d 10.21 mmol/L
i 8.6-10.0 mg/dl
u
m
P
o
t
a
s
s
i
u
m
Cal-
cium
4 Urea 9.3 16.6-48.5 mg/dL
Creatinine 0.66 0.70-1.20 mg/dl
5 Albumin 3.4 3.5-5.0 g/dl

6 Alkaline phosphatase 108.54 34-104 U/L
Table-14: Diagnostic tests for Ascites and cellulitis with T2DM Co-morbid Dis-
ease-
Dia- Ye Hyperten- yes Heart Prob- X Kidney Disor- X

betes s sio lems der
n
Eating Habits-
Vegetarian Yes Eggetarian X Non-Vegetarian Yes

(NONG)

He was eating 5 meals each day; a few dietary changes were made in his diet for a faster recovery and to
52
minimise unnecessary stomach tension. The patient's fluid intake was observed. The patient only eats
soft foods and does not consume Roti.
Physically Active- Inactive.

DRUG PRESCRIBED-
Tab Eritel 40 mg Once Daily
Tab Gluvilda 1000mg Twice a day
Tab vicra 25 mg Once daily
Table-15: Medications prescribed

planning the diet an interaction was done with the patient to know about his food choices, likes and dis-
mined. To recuperate, eating a diet rich in protein and low in salt, fluid was recommended. Roti was
substituted with Dalia and khichdi.
GOALS-
1. To maintain blood pressure and blood sugar levels

2. To reduce ascites and maintain overall health
3. To monitor fluid partake and reserve infection
DIET PRESCRIBED- Diabetic Soft Diet was Prescribed

Table-16: Diet prescribed for Ascites and cellulitis with T2DM
M M MEA-
E E SURE
A N
L U
(6:00
-7:00
AM)
53
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
-Brown Bread Sandwich 1.Glass (200 ml)
with paneer / Idli
Toned Milk 2.small
cheela/Moong dal
Cheela/
Paneer)
(11:00-12:00 PM)
Lunch -Cereal: Khichdi/ Dalia 1 medium bowl
(1:00- Rice boiled 1 medium
1:30 PM) bowl (twice
a week)
-Vegetable: Seasonal Vegetable
Boiled Salad 1 medium Ka-
-Dal: Whole Dal, Soya Preparation tori
or Paneer 200 gm
-Curd: Fresh Curd/Vegetable Raita 1 medium Ka-
tori
1 small Katori
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
din-
ner
(5:3
0-
6:00
PM)
Dinner -Cereal: Dalia 1 Medium Ka-
(7:00-8:00 PM) -Vegetable: Seasonal Vegetable tori
Boiled Salad 1 Medium Ka-
54
-Dal: Whole Dal, Soya Preparation tori
or Paneer 200 gm
-Curd: Fresh Curd (Toned Milk) 1 Medium Ka-
tori
1 Small Katori
- Dessert (sabot dana kheer Optional- 1

without sugar) small bowl
Bedtime Milk with turmeric (Toned Milk) 1 Cup (200ml)
(½ hour before
sleep)

• Wash your hands frequently.
• Eat meals without adding extra salt. Reduce your daily intake of cooking salt to 3–4 grams
• cholesterol and saturated fat consumption.
FOOD INCLUDED-
• When feeling hungry, consume low in calories items like salads, clear soups, sprouts, plain
buttermilk, bhuna Channa.
55
recommended.
• Fruits such as Apricot, Plum, apple, papaya, Jamun, Guava, pear.
• Add a dash of turmeric, one teaspoon of ginger extract, and five drops of Tulsi spice leaf juice to
each glass of milk (milk should be sugar-free)
FOOD AVOIDED-
• For dals, sprouts, salads, soups, etc., add little lemon juice to each dish
• Avoid Raw and uncooked food like raw salads consume boiled or steamed salad.
• Limit tea and coffee.
• Vegetables like GLVS and roots and tubers e.g., potato, Arbi, sweet potato, yam, beetroot.
• Fruits with main meals should be had in between meals; mango, banana, Cheeku, Custard apple,
grapes, litchi, all citrus fruits and sweet melon should be avoided.
OUTCOME
Pain and agitation subsided. Ascites decreased and cellulitis successfully treated, there were no signs of
vomiting, and blood sugar levels were normal.
56
4.6 CASE STUDY-6
(Diabetes mellitus and Acute febrile illness) SUBJECT
PROFILE-
• NAME –WXX
• AGE – 66
• GENDER-Female
• BODY WEIGHT-83.4 kg
• BMI- 33.6 kg/m2
• DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Fever (3-4 Days), Weakness, Body pain, morbid
obese
• PAST MEDICAL CONDITION- Diabetic from past 6 years, post spinal surgery
• DIAGNOSIS-AFI and T2DM

TEST-
® Pulse –110 per min
® TEMP-101.2 F
® Sp02- 94%
57
S.NO PARAMETERS TEST RESULT NORMAL
RANGE
1 RBS 424 70-140 mg/dl
3 Sodium 125.4 135-148 mmol/L
Potas- 4.22 3.50-5.30
sium 9.28 mmol/L
Cal- 8.8-10.2 mg/dl
cium
4 U 20.2 16.6-48.5 mg/dL
r 0.75 0.50-0.90 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 3.8 3.5-5.0 g/dl
6 Bicarbonate 17.4 22-29 mEq/L
Table-17: Diagnostic tests for acute febrile illness and T2DM Co-morbid Dis-
ease-
Dia- Y Hyperten- X Heart Prob- X Kidney X

betes es sion lems Disorder
Eating Habits-
Vegetarian (No Onion No Yes Eggetarian yes Non-Vegetarian yes
Garlic)
She was eating 5 meals per day that were unrelated to her medical condition. Certain dietary changes
were made in her diet to help the patient recover faster and maintain a healthy weight. The dietary his-
58
tory study revealed that the patient ate large meals, never saw a dietitian, and was solely on medications.
Physically Active- She was not physically active and was discovered to be dependent on family mem-
bers for her day-to-day regular tasks.
DRUG PRESCRIBED-
Vitamin D2 weekly
Iron supplement Once daily
Paracetamol SOS
mined. The patient was given a high- fibre diet and more fluids. As the sodium levels were low, addi-
tional salt was given to the patient.
GOALS-
1. To maintain a healthy body weight and good nutritional status
2. To prevent other complications and maintain blood sugar
3. To provide high protein, high fibre and low-fat diet DIET PRE-
SCRIBED- Diabetic Soft Diet was Prescribed
4. Table-19: Diet prescribed for AFI and T2DM
M M MEA-
E E SURE
A N
L U
(6:00
-7:00
59
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma)
2
with paneer / Idli
Toned Milk
1 small
cheela/Moong dal
Cheela/
Paneer)
Mid-Morning Fruit: Apple/Papaya (100 gm)
(11:00-12:00 PM)
Lunch -Ce- 2
(1:00- real: 1 medium bowl
1:30 PM) Soft
Chap-
atti/ 1 medium Ka-
Khichd tori
i/ Dalia 200 gm
1 medium Ka-
-Vegetable: tori
S
ea
so 1 small Katori
n
al
V
e
g-
et
a
bl
e
S
al
a
d
-Dal: Whole Dal,
60
Soya Preparation or
Paneer
-Curd: Fresh Curd/

Vegetable Raita
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d

(½ hour before
sleep)

61
FOOD INCLUDED-
• Lemon water, a thin, sugar-free lassi, coconut water (150 ml) and vegetable soup.
recommended.
FOOD AVOIDED-
62
• Don’t consume ketchup, jam, jelly, ajino-motto, packaged juices, canned items and salted butter,
cheese.
• Products created from refined flour include biscuits, cakes, noodles, and macaroni.
• Avoid eating dry fruits like dates, cashews, and raisins.
• Avoid sugar, sweets, chocolates, ice- cream, jaggery, cold drinks, shakes, squashes, canned
juices etc
• It is not wise to utilise table salt.
• Avoid heavy meals at dinner like rajma, chole, kadhi, urad dal etc
OUTCOME
Patients' conditions improved as a result of the modifications to diets mentioned above. Random blood sugar at
admission:424 mg/dl to 220 mg/dl at discharge.
63
4.7 CASE STUDY-7
(Diabetes mellitus and Acute Gastroenteritis)
SUBJECT PROFILE-
• NAME –PXX
• AGE – 63
• GENDER-Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- 20 episode of loose stool, abdominal pain, Generalised
weakness, Headache
• PAST MEDICAL CONDITION- Diabetes type-2, hypertension
• DIAGNOSIS-AGE with Dehydration

TEST-

® TEMP-99.8 F
® Sp02- 97%

RANGE
1 RBS 351 70-140 mg/dl
HBA1c 9.9 4.27-6.07%
64
3 Sodium 132.8 135-148 mmol/L
Potas- 5.44 3.50-5.30
sium 8.89 mmol/L
Cal- 8.6-10.0 mg/dl
cium
4 U 42.5 16.6-48.5 mg/dL
r 1.00 0.70-1.20 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 4.4 3.5-5.0 g/dl
Table-20: Diagnostic tests for AGE and T2DM Co-morbid Dis-

ease-
Dia- Y Hyperten- ye Heart X Kidney Disor- X

betes es sion s Problems der
Eating Habits-

The patient was eating three meals each day. His nutritional history made it clear that he enjoyed eating
outside snacks, especially fried ones. He had three servings of full- cream milk.
Physically Active- The patient is dormant.
DRUG PRESCRIBED-
Telma- H 40 mg Once daily
65
Inj ofloxacin 100ml Twice a day
Iron supplement Weekly
Table-21: Medications prescribed NUTRITIONAL

INTERVENTIONS
mined. The patient was prescribed a low- potassium diet. He was told to abstain from milk, tea and pa-
paya until his stools became solid.
GOALS-
1. To prevent dehydration and rehydrate the patient
2. To maintain electrolyte balance
3. To regulate blood sugar and blood pressure
DIET PRESCRIBED- Diabetic Soft Diet (Low potassium) was Prescribed
Table-22: Diet prescribed for AGE and T2DM
M M MEA-
E E SURE
A N
L U
(6:00
-7:00
AM)
66
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
1 Glass (200 ml)
-Brown Bread Sandwich
with paneer / Idli
Toned Milk
1 small
cheela/Moong dal
Cheela/
Paneer)
Mid-Morning Fruit: Apple/Guava/ Pear (100-150gm)
(11:00-12:00 PM)
boiled bowl (twice
a week)
1 medium Ka-
tori
67
-Vegetable: Seasonal Vegetable
(low potassium) 200 gm
Salad
1 medium Katori
-Dal: Whole Dal, Soya Prepara-
tion or Paneer
1 Medium Katori
-Curd: Fresh Curd/Vegetable
Raita
Eve -Tea or herbal tea without Sugar 1 Cup
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
din-
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
sium)
Salad 200 gm

-Curd: Fresh Curd

sugar)
(½ hour before
sleep)
68
• Only consume home-cooked meals.

• Cooking methods like boiling, steaming, grilling is advised
• Partake of only the recommended amount of vegetables and pulses.
• .
FOOD INCLUDED-
• Oral rehydration solution (100-150ml) can be taken.

recommended.
FOOD AVOIDED-
69
• If you have diarrhoea or gastritis, stay away from milk and its products besides those that are yo-
ghurt-based.
• Limit your coffee and tea intake.
cheese.
• It's best to completely avoid drinking alcohol and smoking.

• Avoid heavy meals at dinner like rajma,chole,kadhi,urad dal etc
• Avoid papaya in case of diarrhoea.
OUTCOME-
The patient's condition got better with no trace of nausea or vomiting. Oral intake improved, and there
were no new problems. At admission, Random blood sugar was 351 mg/dl and at discharge, it was 195
mg/dl.
70
4.8 CASE STUDY- 8
(Diabetes mellitus and Acute stroke)
SUBJECT PROFILE-
• NAME –WQQ
• AGE – 57
• GENDER- Female
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Slurring of speech, difficulty walking, vertigo, weak-
ness (3-4 days), Dull
• PAST MEDICAL CONDITION- Diabetes type-2
• FAMILY HISTORY- No contributory history founded.
• DIAGNOSIS-Acute Stroke

TEST-
® TEMP-98 F
71
® Sp02- 94%

RANGE
1 RBS 146 70-140 mg/dl
HBA1c 6.5 <5.7%
3 S 136.9 135-148 mmol/L
o 3.73 3.50-5.30
d 9.2 mmol/L
i 8.8-10.2 mg/dl
u
m
P
o
t
a
s
s
i
u
m
Cal-
cium
4 U 43.3 16.6-48.5 mg/dL
r 0.20 0.50-0.90 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 3.6 3.5-5.0 g/dl
6 Vit-D 10.48 20 and 40 ng/mL
72
7 Cholesterol 286 <200 mg/dl
LDL Cholesterol 207 <100 mg/dl
Table-22: Diagnostic tests for Acute stroke and T2DM

*MR angiography of brain shows: Distal basilar artery appears attenuated possibly underlying thromboembolic
disease.
Co-morbid Disease-
Dia- Y Hyperten- X Heart Prob- X Kidney Disor- X

betes es sion lems der
Eating Habits-
Vegetarian Yes Eggetarian X Non-Vegetarian yes

The patient attendant briefed about patient's nutritional intake history, stating that she had a lack of ap-
petite and was unable to ingest the appropriate number of meals. Three meals a day were being con-
sumed by her.
There was a clear low food intake overall. Also, the consumption of greasy foods was high.
Physically Active- She was physically inactive and facing difficulty in walking.
DRUG PRESCRIBED-
Vitamin D2 weekly
B12 Supplement Once daily
Clopidogrel 75Mg Tablet Once daily

INTERVENTIONS
Based on the diagnosis and partake of food, dietary modifications were planned for the patient. Dietary
alterations were made in the patient's diet to prevent recurrent strokes, as well as adaptations to meet
symptoms such as trouble swallowing. A diet high in fruits and vegetables, lean protein, whole grains,
and foods low in added salt was recommended.
GOALS-
73
1. To maintain blood sugar levels
2. To provide adequate nutrition
3. To limit the intake of salty and oily foods
DIET PRESCRIBED- Diabetic Soft Diet (Semi-Blended) was Prescribed
Table-24: Diet prescribed for Acute stroke and T2DM
M M MEA-
E E SURE
A N
L U
Earl -Tea or herbal tea Without Sugar 1 Cup
(6:00
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
with paneer / Idli
Toned Milk 1 small
cheela/Moong dal
Cheela/
Paneer)
(11:00-12:00 PM)
1:30 PM) Dalia Rice
boiled
1
-Vegetable: Seasonal Veg- medium
etable Salad bowl
(twice a
-Dal: Whole Dal, Soya Preparation week)
74
or Paneer 1 medium
Katori
-Curd: Fresh Curd/Vegetable Raita 200 gm
1 medium
Katori
1 small Ka-
tori
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d
-Dal: Whole Dal, Soya 1 Small Katori

Preparation or Paneer Optional- 1
small bowl
-Curd: Fresh Curd
(Toned Milk)
- Dessert (sabot
dana kheer without
sugar)
75
(½ hour before
sleep)

• Never miss meals. Eat meals and snacks at the same times every day to prevent high blood sugar

• Using water to prepare veggies instead of roasting or frying them will make them softer.
• To remove seeds and skins, foods are filtered or strain.
Group A consists of olive oil, canola oil, and rice bran oil.Group B consists of refined oils, groundnut oils,
soybean oils, and mustard oils.
FOOD INCLUDED-
recommended.
76
FOOD AVOIDED-
cheese.
juices etc
• Avoid heavy meals at dinner like rajma,chole,kadhi,urad dal etc.
• Minimize the consumption of spices
• It's best to completely avoid drinking alcohol and smoking.
• Avoid taking drinks high in caffeine
OUTCOME- A steady vital sign improvement.
77
4.9 CASE STUDY- 9
(Diabetes mellitus and Urinary tract Infection) SUBJECT
PROFILE-
• NAME –XXX
• AGE – 63
• GENDER- Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Shortness of breath (3-4 days), orthopnoea, no history
of cough, fever, painful urination, burning sensation while urinating.
• PAST MEDICAL CONDITION- Diabetes type-2, Hypothyroidism, Hypertension
• FAMILY HISTORY- His Father has a history of Diabetes mellitus type 2 from past 20 years
and was also having history of hypertension.
• DIAGNOSIS-UTI

TEST-
78
® TEMP- 98 F
® Sp02- 99%

RANGE
1 RBS 244 70-140 mg/dl
HBA1c 7.2 <5.7%
3 Sodium 135.9 135-148 mmol/L
Potassium Cal- 3.72 3.50-5.30 mmol/L
cium 9.63 8.6-10.0 mg/dl
4 U 50.2 16.6-48.5 mg/dL

r 0.98 0.70-1.20 mg/dl
e 26 8-26 mg/dl
a
C
r
e
a
t
i
n
i
n
e
BUN
5 Albumin 4.2 3.5-5.0 g/dl
6 Bicarbonate 19.0 22-29
Table-25: Diagnostic tests for Urinary tract infection and

T2DM Co-morbid Disease-
Dia- Y Hyperten- ye Heart Prob- X Kidney Disor- X

betes es sion s lems der
Eating Habits-
Vegetarian (No Onion No Gar- Yes Eggetar- X Non- Y

lic) ian Vegetarian es
79
He was eating three meals a day, and certain nutritional changes were made to his diet to hasten his recu-
peration. He takes less water overall and perspires more.
• Breakfast: 4 toasts with jam/peanut butter, milk (1 glass-250 ml)

• Lunch consists of rice (two bowls), four rotis, one bowl of sabzi, and fried items like samosas
and pakoras.
• Dinner consists of 4 Rotis, 1 bowl of dal/chicken, 1 Katori of rice, and dessert.
Physically Active- The patient is moderately active.

DRUG PRESCRIBED-
Cephin-500 Once daily
Iron supplement Weekly

Based on the diagnosis and partake of food, dietary modifications were planned for the patient.Yoghurt
and citrus fruits were provided Caffeine consumption was restricted since it irritates the bladder. Probi-
otics and antioxidants of high grade were added in the diet.
GOALS-
1. To relieve the symptoms of infection

2. To prevent serious complication
3. To protect the kidneys
4. To prevent tissue damage and control blood sugar
Table-27: Diet prescribed for urinary tract infection and Type-2 Diabetes
M M MEA-
E E SURE
A N
L U
Earl -Tea or herbal tea Without Sugar 1 Cup
80
(6:00
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
with paneer / Idli
Toned Milk 1 small
cheela/Moong dal
Cheela/
Paneer)
(11:00-12:00 PM)
boiled bowl (twice
a week)
Boiled tori
salad 200 gm
-Dal: Whole Dal, Soya Preparation 1 medium Ka-

or Paneer tori

1 Medium Ka-
tori
Eve -Tea or herbal tea without Sugar 1 Cup
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
ner
(5:3
81
0-
6:00
PM)
Dinner -Cereal: Soft Chapatti (With Bran)/ 2 medium size
(7:00-8:00 PM) Dalia 1 Medium Ka-

-Vegetable: Seasonal Veg- tori
etable 1 Medium Ka-
Boiled Salad tori
200 gm
Preparation or Paneer 1 Medium Ka-
tori
-Curd: Fresh Curd (Toned
Milk)
- Dessert (sabot dana 1 Small Katori
kheer without sugar) Optional- 1
small bowl
(½ hour before
sleep)
*Oil- 2-3 tbsp * Sugar- Avoid or limit * salt-3gm/day *Fluid –3000ml/day

• Never miss meals. Eat meals and snacks at the same times every day to prevent high blood sugar
82
FOOD INCLUDED-
• Fennel, turmeric, cumin, mint, and fenugreek water or herbal tea should be incorporated.
recommended.
FOOD AVOIDED-
• Red, green, and black pepper should be avoided
• Vegetables like roots and tubers e.g., potato, Arbi, sweet potato, yam, beetroot, tomato, raw
salad, frozen vegetables.
• Don’t consume ketchup, jam, jelly, ajinomotto, packaged juices, canned items and salted butter,
cheese.
OUTCOME- The patient's health improved, and fluid consumption was increased.
Improved urine production with no discomfort or burning feeling. Blood glucose levels and blood pres-
83
sure were within normal limits.
84
4.10 CASE STUDY-10
(Diabetes mellitus and coronary artery disease) SUBJECT
PROFILE-
• NAME –XVZ
• AGE – 65
• GENDER- Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Dyspnoea, breathing difficulty, constipation, cough, re-
duce oral intake, chest pain
• PAST MEDICAL CONDITION- T2DM, Hypothyroidism
• DIAGNOSIS-Uncontrolled T2DM, CAD

TEST-
® TEMP-98 F
® Sp02- 97%
S.NO PARAMETERS TEST RE- NORMAL

SULT RANGE
1 RBS 338 70-140 mg/dl
HBA1c 7.8 <5.7%
3 Sodium 131.0 135-148 mmol/L
Potas- 4.29 3.50-5.30 mmol/L
sium 8.67 8.6-10.0 mg/dl
Cal-
cium
85
4 Urea 24.8 16.6-48.5 mg/dL
Creati- 0.84 0.70-1.20 mg/dl
nine 11.58 8-26
BUN
5 Albumin 3.5 3.5-5.0 g/dl

6 Bicarbonate 30.6 22-29
7 L
i 220 <200 mg/dl
p 28 >40 mg/dl
i 166 <150 mg/dl
d 115 <100 mg/dl
p
r
o
f
i
l
e
C
h
o
l
e
s
t
e
r
o
l
86
D
L
T
r
i
g
l
y
c
e
r
i
d
e
s
L
D
L
Table-28: Diagnostic tests for CAD and T2DM Co-morbid Dis-

ease-
Dia- Y Hyperten- X Heart Prob- Ye Kidney Disor- X

betes es sion lems s der
Eating Habits-
Vegetarian (No Onion Ye Eggetar- Yes Non- Y

No s ian Vegetarian es
Garlic)
The patient ate 5 meals each day, all of which were heavy in outside foods and fried snacks. His appetite was
normal.
Physically Active- Poor physical fitness.
87
DRUG PRESCRIBED-

T.Flavedon MR 35 mg Once daily (OD)
T.clopital Once daily (OD)
T.Ecosprin Av 75 mg Once daily (OD)
Pan 40 mg Before breakfast
Metformin 500 mg Twice a day

Based on the diagnosis and partake of food, dietary modifications were planned for the patient. The patient's
diet was supplemented with soluble fibre. A well-balanced meal of protein, unsaturated fats, vitamins, miner-
als, and carbs was provided. A high protein diet was suggested, which was supplemented with protein powder.
GOALS-
1. To prevent and manage elevated blood cholesterol levels.
2. To Reduce your intake of salt and fried foods.
3. To offer appropriate nutrients.
4. To keep blood glucose levels stable
DIET PRESCRIBED- Diabetic Soft Diet (High Protein) was Prescribed
Table-30: Diet prescribed for CAD and Type-2 Diabetes
M M MEA-
E E SURE
A N
L U
(6:00
-7:00
AM)
88
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
with paneer / Idli
Toned Milk 2.small
cheela/Moong dal
Cheela/
Paneer)
(11:00-12:00 PM)
boiled bowl (twice
a week)
-Vegetable: Seasonal Veg- 1 medium Ka-
etable Salad tori
200 gm
tori
1 small Katori
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre-dinner -Soup 1 bowl
(5:30-6:00 PM)
89
Bran)/ Dalia tori
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d

small bowl
-Curd: Fresh Curd
(Toned Milk)
- Dessert (sabot
dana kheer without
sugar)
Bedtime Milk with protein pow- 1 Cup (250ml)
(½ hour before der (Toned Milk)
sleep)
90
• The majority of the time, every meal preparation should be presented broiled, grilled, or steam-
cooked rather than fried.
FOOD INCLUDED-
• Increase partakes of prebiotics and probiotics.
recommended.
FOOD AVOIDED-
• Don’t consume ketchup, jam,jelly,ajinomotto,packaged juices, canned items and salted butter,
cheese.
• Avoid saturated fats such as butter, coconut oil, ghee, hydrogenated oil etc.
91
• Avoid using cream, butter, cream milk, desi ghee, dalda, and buffalo milk, among other
things.
juices etc
• Minimize the consumption of spices
• Reduce overall Caffeine intake to 1-2 cups.
OUTCOME- The patient was stable and was now engaging in modest physical activity. Vital signs have im-
proved.
4.11 CASE STUDY- 11

(Diabetes mellitus and Osteoporosis) SUBJECT
PROFILE-
• NAME –QAB
• AGE – 64
• GENDER- Female
DRUG- Not Known
MEDICAL ASSESSMENT
92
• PRESENT MEDICAL CONDITION- The patient was admitted to the hospital with severe
back ache, generalised weakness, low oral intake and polyuria.
• PAST MEDICAL CONDITION- The patient had diabetes type –2 from past 10 years, Hyper-
tension, hypothyroidism (8 years)
• DIAGNOSIS-Osteoporosis

TEST-
® TEMP-97 F
® Sp02-99 %

RANGE
1 RBS 139 70-140 mg/dl
HBA1c 7.9 <5.7%

3 Sodium 137.0 135-148 mmol/L
Potas- 3.41 3.50-5.30
sium 6.3 mmol/L
Cal- 8.8-10.2 mg/dl
cium
4 U 37.9 16.6-48.5 mg/dL
r 0.87 0.50-0.90 mg/dl
e
a
C
r
e
a
t
i
n
i
n
93
e
5 Albumin 2.0 3.5-5.0 g/dl
Table-31: Diagnostic tests for Osteoporosis and T2DM Co-morbid Disease-
Dia- Ye Hyperten- Ye Heart X Kidney Disor- X
betes s sio s Problems der
n
Eating Habits-
Vegetarian (NONG) Yes Eggetarian X Non-Vegetarian Yes
Every day, the patient ate three meals: breakfast, lunch, and dinner. Since it was clear from the patient's
dietary history that she didn't enjoy milk, counselling was conducted to increase her calcium intake.-
Physically Active- She carried out domestic tasks as she was a housewife.
DRUG PRESCRIBED-
Vitamin D2 weekly
Alendrate 70 mg Weekly
Tab. Oscabon 60 K Weekly

INTERVENTIONS
mined. Dietary supplements to strengthen bones have been suggested as follows:
✓ Vitamin-D: 400–1000 IU per day

✓ Calcium: 1200 mg each day
✓ Magnesium: 300-500 mg every day.
✓ Her diet was supplemented with milk containing protein powder. The patient was put on a high protein
and calcium diet.
GOALS-
1. To maintain bone health
2. To prevent fracture and provide adequate nutrition
94
3. To regulate blood glucose
DIET PRESCRIBED- Diabetic Soft Diet (High protein and High calcium) was Prescribed
Table-33: Diet prescribed for osteoporosis and Type-2 Diabetes
M M MEASURE
E E
A N
L U
Early -Tea Without Sugar 1 Cup
Morning -Nuts Or Biscuits 2
(6:00- (Marie/ Oats/ Digestive / High Fiber Bis-
7:00 AM) cuits)
Breakfast -Cereal: (Daliya Porridge/ 1 medium bowl
(8:00-9:00 AM) Oats/ Wheat Flakes /Veg-
etable Poha/ Vegetable Upma)
-Brown Bread Sandwich with pa-

neer / Idli 2
Toned Milk with protein powder 1.Glass (250 ml)
-Protein:(Besan cheela/Moong
dal Cheela/ 2.small
Paneer) 50 gm

(11:00-12:00 PM)
Lunch (1:00- -Cereal: Soft Chapatti/ 2
1:30 PM) Khichdi/ Dalia 1 medium bowl
Rice boiled 1 medium bowl (twice a
week)
-Vegetable: Seasonal Vegetable 1 medium Katori
Salad 200 gm
1 medium Katori
-Dal: Whole Dal, Soya Prepara-

tion or Paneer
1 small Katori
-Curd: Fresh Curd/Vegetable
Raita
95
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d

small bowl
-Curd: Fresh Curd
(Toned Milk)
- Dessert (sabot
dana kheer without
sugar)
Bedtime Milk with protein pow- 1 glass (250ml)
(½ hour before der (Toned Milk)
sleep)

96
FOOD INCLUDED-
recommended.
• Vitamin-d: milk products, soy beverages, orange juice, and mushrooms.
• Calcium: Sources of calcium include milk, milk-based foods like cheese and yoghurt, almonds,
broccoli, cabbage, okra, and pumpkin, as well as French beans, soybeans, lentils like black-eyed
peas, and fruits like oranges and figs.
• Magnesium-rich foods include Avocado, spinach, almonds, broccoli, green peas, and beans.
• Whole grains, cereals, beans, dark green leafy vegetables, papaya, and oranges are good sources
of vitamin B6, B12, and folic acid.
FOOD AVOIDED-
• Sugar and phosphate additives
• juices from fruits, milkshakes, carbonated beverages, caffeinated drinks, desi ghee, and butter
97
OUTCOME- Improved bone health and flexibility. No discomfort in the back, no weakness, and an increased
appetite were noticed. Calcium levels were normal, and the RBS was under control.
4.12 CASE STUDY-12

(Diabetes mellitus and Anemia)
SUBJECT PROFILE-
• NAME –ZXX
• AGE – 53
• GENDER- Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Vomiting, a mild fever on and off, constipation for two
days, persistent anaemia, weakness, headache, pale complexion, and shortness of breath
• PAST MEDICAL CONDITION- The patient has a history of type 2 diabetes from past 7-8
years
• FAMILY HISTORY- NIL
• DIAGNOSIS- Severe Anemia
TEST-

98
® TEMP- 98 F
® Sp02- 98%

RANGE
1 RBS 237 70-140 mg/dl
HBA1c 7.2 <5.7%
Total Leucocyte Count 3.57 4.0-10.0 10-9/L
3 Sodium 135.4 135-148 mmol/L
Potas- 4.98 3.50-5.30
sium 8.81 mmol/L
Cal- 8.6-10.0 mg/dl
cium
4 U 18 16.6-48.5 mg/dL
r 0.92 0.70-1.20 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 3.4 3.5-5.0 g/dl
6 Total Iron Binding
Capacity Iron 16 70-180 mcg/dl
UIBC 384 155-355 mcg/dl
Total iron binding capac- 400 225-535 mcg/dl
ity
Table-33: Diagnostic tests for anemia and T2DM Co-morbid Dis-

ease-
Dia- Y Hyperten- X Heart Prob- X Kidney Disor- X

betes es sion lems der
99
Eating Habits-
Vegetarian (No Onion No Gar- Yes Eggetar- X Non- Y

lic) ian Vegetarian es
He ate two meals every day: breakfast and dinner. He was only eating fruits for lunch, which indicated
improper consumption and a lack of nutritional intake.
Physically Active- He participated in modest physical activity at work.DRUG PRESCRIBED-

Vitamin D2 weekly
Iron supplement Once daily
Folic acid tablet Once daily
Vitamin C Supplement Once daily

INTERVENTIONS
mined. A diet high in iron, B vitamins, and vitamin C was suggested.
GOALS-
1. To prevent other complications

2. To provide adequate nutrition and treat anaemia
3. To control blood glucose
DIET PRESCRIBED- Diabetic Normal diet (Iron rich) was Prescribed

Table-35: Diet prescribed for anemia and T2DM
M M MEA-
E E SURE
A N
L U
10
0
(6:00
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable 1
Upma)
Whole wheat Roti 2
with paneer / Idli
Toned Milk 1 small
-Protein:(Besan cheela/ 40 gm
Moong dal or ragi Cheela/
Paneer)
(11:00-12:00 PM)
Lunch (1:00-1:30 -Cereal: 2
PM) Bajra 1 medium bowl
Chap-
atti/
Khichdi/
Dalia
Rice boiled 1
medium
-Vegetable: Sea- bowl
sonal (twice a
Veg- week)
etable 1 medium
Salad Katori
200 gm
Preparation or Paneer 1 medium
Katori
-Curd: Fresh Curd/Veg-
etable Raita
1 small Ka-
tori
Eve -Tea without 1 Cup
10
1
ning Sugar or herbal
Tea tea(lemon- 1 small bowl
(4:0 grass)
0- -Non-Fried Snack
4:30 (sprouts, fruit
PM) salad)
Pre- - 1 bowl
din- S 1 glass (200)
ner o
(5:3 u
0- p
6:00
PM) O
r
a
n
g
e
j
u
i
c
e
Bran)/ Dalia tori
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d

small bowl
-Curd: Fresh Curd
(Toned Milk)
- Dessert (sabot dana
kheer without sugar)
(½ hour before
10
2
sleep)
*Oil- 2-3 tbsp * Sugar- Avoid or limit * salt-5gm/day *Fluid –3000ml/day
• Foods enriched with iron, such as many morning cereals, can help increase reserves.
• For at least three hours after eating iron-rich meals, stay away from calcium- rich foods.
FOOD INCLUDED-
• Consume more citrus fruits, legumes, nuts, green leafy vegetables, and Fortified foods.
• Add some lemon juice to your salads and lentil dishes to increase your body's absorption of
iron.
• Lotus stem, millets such as bajra and ragi, and cereals.

• Consume salad and boiled vegetables such as radish, cucumber, cabbage, spinach, bottle gourd,
and bitter gourd.
• Vegetables such as Ghia, tori, tinda, pumpkin, beans, carrot, leafy greens, capsicum, zuc-
10
3
chini and others are recommended.
FOOD AVOIDED-
• High-salinity foods
• Steer clear of meat and animal products.
• Just 1-2 cups of caffeinated beverages should be consumed daily.
cheese.
• Avoid sweets,chocolates,ice- cream,jaggery, cold drinks, shakes, squashes, canned juices etc
10
4
OUTCOME-With the proper care and therapy, the patient's condition improved. The right diet and iron
supplementation enabled the HB levels to get back to normal in a period of approximately two weeks.
4.13 CASE STUDY-13

(Uncontrolled Diabetes mellitus Type-2 with Diabetic Ketoacidosis Complication)
SUBJECT PROFILE-
• NAME –BBA
• AGE – 88
• GENDER- Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Altered sensorium, Uncontrolled blood sugar, Nausea,
low appetite, Septic shock, Extreme weakness, dehydration, Frequent urination
• PAST MEDICAL CONDITION- T2DM from past 20 years and hypertension was recently di-
agnosed
• DIAGNOSIS-DKA
TEST-
® TEMP- 98 F
10
5
® Sp02- 95 %

RANGE
1 RBS H1 70-140 mg/dl
HBA1c 7.6 <5.7%
3 S 143.5 135-148 mmol/L
o 3.71 3.50-5.30
d 9.34 mmol/L
i 8.6-10.0 mg/dl
u
m
P
o
t
a
s
s
i
u
m
Cal-
cium
4 U 123.9 16.6-48.5 mg/dL
r 3.48 0.70-1.20 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 Albumin 2.5 3.5-5.0 g/dl
6 CRP 199.16 <5.0 mg/L
7 Urine-Ketone Present NIL
10
6
Table-36: Diagnostic tests for DKA and T2DM
*NOTE- The H1 or HI value indicates an extremely high blood glucose level that is impossible to de-
tect with a glucometer. This is because HI/H1 on a blood glucose metre is a number above the identifi-
able value indicating that a person's blood glucose level is abnormally high.
Co-morbid Disease-
Dia- Y Hyperten- Yes Heart Prob- X Kidney Disor- X

betes es sio lems der
n
Eating Habits-
Vegetarian Yes Eggetarian yes Non-Vegetarian yes

The patient had a poor appetite and consumed little food overall. The patient had been drinking just liq-
uids for the previous two days since he was unable to eat solid meals.
Physically Active- Due to his advanced age, he did not engage in any sort of physical activity.
DRUG PRESCRIBED-

Vitamin D2 weekly
Twice a day
Humalog 100IU
Ensure Diabetes Care Powder Twice a day
Based on the diagnosis and partake of food, dietary modifications were planned for the patient. Due to
the patient's inability to swallow food, a diabetic renal RT feed of 100 ml was prepared, Renal because
his urea levels were extremely elevated at the time of admission. This was followed by a diabetic RT
feed of 150 ml that contains 1514 kcal and 57.2 gm protein, to which a diabetic ensure powder was
added because of extremely low albumin levels. The RT contained Dal feed, khichdi feed, Milk feed,
lassi feed, rose water feed etc. After being 3 days on RT feed, the patient's diet was switched to a dia-
10
7
betic soft diet.
GOALS-
1. To maintain normal blood glucose level and blood pressure
2. To provide adequate nutrition and prevent dehydration
3. To prevent and delay other diabetes complication.
4. To provide Relief from symptoms
DIET PRESCRIBED- Diabetic Soft Diet (HP) was Prescribed

Table-37: Diet prescribed for DKA and T2DM
M M MEA-
E E SURE
A N
L U
(6:00
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
with paneer / Idli
Toned Milk 2.small
cheela/Moong dal
Cheela/
Paneer)
10
8
(11:00-12:00 PM)
boiled bowl (twice
a week)
Boiled or Steamed tori
Salad 200 gm
-Dal: Whole Dal, Soya Preparation 1 medium Ka-

or Paneer tori

1 small Katori
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
din-
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
Vegetable tori
Boiled 200 gm
Salad
1 Medium Ka-
-Dal: Whole Dal, Soya tori
-Curd: Fresh Curd 1 Small Katori

(Toned Milk) Optional- 1
- Dessert (sabot small bowl
10
9
dana kheer without
sugar)
(½ hour before
sleep)

• Boiling water should be used to make both coffee and tea.
• Hands should be thoroughly washed, and cleanliness should be maintained.
FOOD INCLUDED-
• Herbal tea that has been prepared with packed tea bags
• Include fruit juices, tea, soups and gruels.
11
0
• Vegetables such as Ghia, tori, tinda, pumpkin, beans, carrot, leafy greens, capsicum, zuc-
chini and others are recommended.
FOOD AVOIDED-
• All raw vegetable sprouts, including broccoli, radish and Alfalfa grass
• Products made from raw grains
• Salad dressing made with aged cheese
• Raw honey
cheese.
OUTCOME-Patients' vital signs stabilised and their overall health Improved. RBS ranged from HI at
admission to 146 at discharge. With only a few dietary changes, albumin and urea levels have been re-
stored to normal.
11
1
4.14 CASE STUDY-14
SUBJECT PROFILE- (Diabetes mellitus and Fatty Liver)
• NAME –ZZZ
• AGE – 57
• GENDER-Male
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- The patient was admitted with complaints of loss of ap-
petite, Nausea,bodyache,headache,dyspepsia and generalised weakness.
• PAST MEDICAL CONDITION- History of T2DM, HTN, Dyslipidemia
• FAMILY HISTORY- NIL
• DIAGNOSIS-Grade-1 Fatty liver ,Dyslipidemia
TEST-

® TEMP- 97 F
11
2
® Sp02-97 %

O RANGE
1 RBS 532 70-140 mg/dl
HBA1c 13.9 <5.7%
2 Haemoglobin 16 13.0-17.0 g/dl
3 Sodium 135.4 135-148 mmol/L
Potas- 3.88 3.50-5.30
sium 8.7 mmol/L
Cal- 8.6-10.0 mg/dl
cium
4 U 32.2 16.6-48.5 mg/dL
r 0.69 0.70-1.20 mg/dl
e
a
C
r
e
a
t
i
n
i
n
e
5 T 6.61 6.6-8.7 g/dl
o 3.9 3.5-5.0 g/dl
t 45.63 <40 U/L
a 23 <41 U/L
l 138.45 40-129 U/L
71.6 7-50U/L
p
r
o
t
e
i
n
A
l
b
11
3
u
m
i
n
S
G
O
T
S
G
P
T
Alkaline
Phos-
phatase
GGTP
6 L
i 239 <200 mg/dl
p 39 >40 mg/dl
i 122 <100 mg/dl
d 148 <150 mg/dl
p
r
o
f
i
l
e
C
h
o
l
e
s
t
e
r
o
l
H
D
11
4
L
C
h
o
l
e
s
t
e
r
o
l
L
D
L
C
h
o
l
e
s
t
e
r
o
l
Triglyceride
Table-43: diagnostic tests for Fatty liver and T2DM

*Ultrasound Whole Abdomen shows Grade 1 fatty liver infiltration.
Co-morbid Disease-
Dia- Y Hyperten- Yes Heart X Kidney Disor- X

betes es sion Problems der
Eating Habits-
Vegetarian Yes Eggetarian yes Non-Vegetarian Yes
He was eating three meals a day, and certain nutritional changes were made to his diet to hasten his re-
cuperation. It was clear that the patient eats a lot of greasy and spicy foods. The patient also had a
11
5
propensity of seasoning his diet with additional salt and ghee. His appetite was good. He drank four
cups of tea a day, which is a lot of caffeine.He also had an unhealthy habit of missing meals and not
paying attention to how much salt, sugar, or fat he consumed.
Physically Active- Prior to becoming ill, he used to go for a 10 to 15-minute stroll in the park to remain
physically fit.
DRUG PRESCRIBED-
Tab.Gluvilda 1000 mg Twice a day
Inj. Emeset 4 mg SOS
Tab.Eritel 40 mg Once daily
Ecosprin AV 75 mg Once daily

INTERVENTIONS
Based on the diagnosis and partake of food, dietary modifications were planned for the patient.The pa-
tient was advised to eat a diet low in salt and cholesterol. It is advised to consume 60 mg of vitamin C
daily.
GOALS-
1. To limit saturated and trans-fat intake
2. To limit salt intake
3. To monitor blood sugar and blood pressure
4. To achieve ideal body weight
Table-45: Diet prescribed for Fatty liver and T2DM
M M MEA-
E E SURE
A N
L U
11
6
Earl -Tea /lime water /amla juice 1 Cup
y Without Sugar
Mor -Nuts Or Biscuits 2
ning (Marie/ Oats/ Digestive / High
(6:00 Fiber Biscuits)
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma) 2
-Brown Bread Sandwich with
paneer /
Idli
11
7
Toned Milk 1 Glass (200 ml)
-Protein:(Besan cheela/Moong
dal Cheela/ 1 small
Paneer) 40 gm
(11:00-12:00 PM)
boiled bowl (twice
a week)
Salad (add lime) tori
200 gm
tori
1 small Katori
Tea fruit salad)
(4:0
0-
4:30
PM)
Pre- -Soup 1 bowl
din-
ner
(5:3
0-
6:00
PM)
11
8
Bran)/ Dalia tori
sonal tori
Veg- 200 gm
etabl
e 1 Medium Ka-
Sala tori
d

small bowl
-Curd: Fresh Curd
(Toned Milk)
- Dessert (sabot
dana kheer without
sugar)
(½ hour before
sleep)
• Herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends are better than table salt to
flavour foods.
• Eat adequate calcium-rich plant-based foods, such as juices with added calcium.
11
9
FOOD INCLUDED-
recommended.
FOOD AVOIDED-
• High-salinity foods (processed meals, canned goods, ketchup, sauces).

OUTCOME
Patient condition was Stable, and symptoms were relieved by dietary modification and medication therapy.
12
0
4.15 CASE STUDY-15
(Diabetes mellitus and chronic kidney disease)
SUBJECT PROFILE-
• NAME –ZXY
• AGE – 82
• GENDER- Female
DRUG- Not Known
MEDICAL ASSESSMENT
• PRESENT MEDICAL CONDITION- Patient admitted in emergency in unconscious state,
raised blood pressure, generalised weakness, decrease responsiveness.
• PAST MEDICAL CONDITION- History of Diabetes type –2 from past 25 years and had acute
on chronic CKD (Maintenance hemodialysis once)
12
1
• DIAGNOSIS-Acute on Chronic CKD/DM/Urosepsis/pyelonephritis
• COVID-19 VACCINATION STATUS-Nil
TEST-
® Pulse –101per min
® TEMP-98 F
® Sp02- 56%

RANGE
1 RBS 350 70-140 mg/dl
HBA1c 12.8 <5.7%
3 S 138.0 135-148 mmol/L
o 4.42 3.50-5.30
d 9.04 mmol/L
i 24.2 8.8-10.2 mg/dl
u 22-29 mEq/L
m
P
o
t
a
s
s
i
u
m
C
a
l
c
i
u
m
Bicar-
bonate
12
2
4 U 85.4 16.6-48.5 mg/dL
r 2.37 0.50-0.90 mg/dl
e 39.93 8-32 mg/dl
a
C
r
e
a
t
i
n
i
n
e
Blood
urea ni-
trogen
5 Total protein 6.54 6.6-8.7 g/dl
Albumin 2.8 3.5-5.0 g/dl
Table-46: Diagnostic tests for CKD and T2DM Co-morbid Dis-

ease-
Dia- Y Hyperten- X Heart Prob- X Kidney Disor- Ye

betes es sion lems der s
Eating Habits-
Vegetar- Yes Eggetarian Yes Non-Vegetarian Yes

ian

The patient's attendant gave a detailed account of the patient's food history. She added that the patient
has not been eating much and just craves Limca (a fizzy beverage). Patient's appetite is poor. Prior being
unwell, she used to eat everything, but now she has no oral intake.
Physically Active- The patient is physically immobile and is completely reliant on her family members.
DRUG PRESCRIBED-
Vitamin D2 weekly
Metformin 500 mg Twice a day
12
3
Tab Vicra 25 mg Once daily

INTERVENTIONS
Based on the diagnosis and partake of food, dietary modifications were planned for the
patient.When the patient was brought to the hospital emergency ward, she was unresponsive and unable
to ingest orally, so nutritional needs were met with Renal Diabetic RT feed 100 ml 2nd hourly, contain-
ing 1380 kcal and 54 g protein and supplemented with Nephro high protein (HP) powder. Within three
days, a diabetic renal soft diet was administered.
GOALS-
1. To Reduce the stress diseased kidney
2. To prevent and delay other complications
3. To maintain blood sugar levels
4. To provide adequate nutrition and protect the individual against infection
DIET PRESCRIBED- Renal Diabetic Soft Diet was Prescribed
Table-48: Diet prescribed for CKD and T2DM
M M MEA-
E E SURE
A N
L U
Earl -Tea/Herbal tea/fennel (water 1 Cup
y Without Sugar)
Mor Biscuits 2
ning (Marie/ Oats/ Digestive / High
(6:00 Fiber Biscuits)
-7:00
AM)
Flakes /Vegetable
Poha/ Vegetable
Upma)
2
with paneer / Idli
Toned Milk
1 small
cheela/Moong dal
Cheela/
12
4
Paneer)
Mid-Morning Fruit: Apple/Papaya (100-150gm)
(11:00-12:00 PM)

boiled bowl (twice
a week)
(low potassium) tori

tori
-Curd: Fresh Curd/Butter-
milk unsalted 1 small Ka-
tori/1 glass
Tea poha,suji upma)
(4:0
0-
4:30
PM)
Pre- Light snack: Sago vada/idli/biscuit 1 bowl
din-
ner
(5:3
0-
6:00
PM)
Bran)/ Dalia tori
sium)

-Curd: Fresh Curd
12
5
sugar)
Bedtime Milk with Nephro HP (Toned Milk) 1 Cup (200ml)
(½ hour before
sleep)


• Soak green leafy vegetables in lukewarm water for 15 minutes before discarding the water to al-
low the leaching process to remove potassium.
• It is best to base your fluid consumption on any recommendations issued by your doctor or dieti-
tian.
• Water should be taken when one is thirsty; fluid excess may be prevented by sipping water
slowly or by sipping from small glasses, as well as by planning the fluid serving at each meal.
FOOD INCLUDED-
12
6
recommended.
• Protein-rich foods include tofu, paneer, low fat milk and its derivatives, and lentils
• Instead of caffeinated tea, the patient can drink caffeine and sugar-free herbal tea.
FOOD AVOIDED-
cheese.
• Consuming raw salads in excess is not recommended.
OUTCOME
With good nutritional care and therapy, the patient became more awake, her SpO2 increased to 98%,
and her consumption of food increased. Clinically, the patient was doing better, and physiotherapy was
suggested. Random blood glucose levels were within a normal range
12
7
CONCLUSION
I conducted my dissertation research study at Fortias Hospital, a multispecialty hospital that of-
fers services in all disciplines and super-specialities. I worked as a dietetic intern at the hospital's food
and beverage department. My daily task was to interact with the patients and provide significant dietary
recommendations for the patients' diet in accordance with their state of health under the supervision of
my hospital guide Dt. Kanchan Khurana (dietician). I regularly encountered numerous patients who
were suffering from various diseases, such as lower respiratory tract infection, urinary tract infection,
respiratory failure, renal disorders, diabetes, hypertension, and so on. In order to further my awareness
of the patient's condition and get insight into potential interventions that could aid in their full recovery,
I also studied the patient's medical records and interacted with them to learn about their dietary history. I
have also emotionally supported patients, counsel them, and engaged them in their treatment plans.
While at internship, I noticed that the majority of patients had Diabetes mellitus, and most of them were
consuming a non-vegetarian diet with a high intake of red meat. Diabetes prevalence has risen in recent
decades as a result of considerable dietary changes, including decreased consumption of vegetables,
fruits, and legumes and increasing consumption of animal-derived and packaged foods. Diabetes is
known serious public health issue that affects people worldwide.
So, I carried out my study, which was focused on the importance of a sustainable plant-based
diet in the management of diabetes mellitus. I studied individuals with Diabetes Mellitus and its major
complications, monitored them, and got insights about the significance of a plant-based diet in diabetes
treatment. I have performed fifteen case studies on patients with type 2 diabetes mellitus and its associ-
ated complications, such as hypertension, chronic renal disease, lower respiratory tract infection,
urosepsis, ketoacidosis, UTI, coronary artery disease, fatty liver, cellulitis, osteoporosis, and so on. The
majority of the cases I evaluated had type 2 diabetes with hypertension, vitamin D deficiency, and low
haemoglobin count.
A diet high in fibre, phytochemicals, antioxidants, protein, vitamins, and minerals and low in
sodium, sugar, and fat (especially saturated and trans-fat) was suggested as a nutritional approach. De-
pending on the medical state and requirements
of the patients, dietary adjustments are made and implemented into their daily routines. Vegetables,
fruits, grains, nuts, and legumes were all part of the recommended diet, which accounts for ten percent
12
8
of calories from fat, fifteen percent from protein, and seventy-five percent from carbs. To mitigate risks
and progression of disease, total sugar, salt, carb type, and fat were carefully tracked. There are some di-
etary guidelines that apply to all subjects, such as the recommendation for small and frequent meals, 30
minutes of walking or other mild exercise, monitoring blood pressure and blood sugar levels, avoid meal
skipping, etc. The dietary instructions alter depending on the patient's co-morbid conditions. Calcium,
iron, vitamin D, and vitamin B12 were given special attention, and supplements were recommended.
The entire internship period has been a tremendous learning experience and has expanded my
understanding of a wide range of diseases, particularly diabetes mellitus and has also enlightened my
knowledge about plant-based eating regimen prescribed for diabetic patients with additional co-morbid
conditions .I dealt with the patients and learnt about the function of sustainable plant-based diets in
meeting daily dietary requirements for the prevention and treatment of type 2 diabetes mellitus.
I also discovered that a plant-based diet is not only healthier for the environment and more sus-
tainable, but it also aids in the treatment of diabetic patients by preserving normal blood sugar levels and
delaying or preventing further complications. For the purpose of preventing and treating diabetes melli-
tus as well as guaranteeing future food security, people should be encouraged to adopt healthy plant-
based diets and it is important to educate the public about the therapeutic benefits of a plant-based diet
for the treatment of type-2 diabetes mellitus.
12
9
REFERENCES
▪ Craig, W. J., Mangels, A. R., Fresán, U., Marsh, K., Miles, F. L., Saunders, A. V., ... & Orlich,
M. (2021). The safe and effective use of plant-based diets with guidelines for health profession-
als. Nutrients, 13(11), 4144.
▪ Fresán, U., & Sabaté, J. (2019). Vegetarian diets: planetary health and its alignment with human
health. Advances in nutrition, 10(Supplement_4), S380- S388.
▪ Goyal, R., & Jialal, I. (2018). Diabetes mellitus type 2.
▪ Hemler, E. C., & Hu, F. B. (2019). Plant-based diets for personal, population, and planetary
health. Advances in Nutrition, 10(Supplement_4), S275-S283.
▪ Jardine, M. A., Kahleova, H., Levin, S. M., Ali, Z., Trapp, C. B., & Barnard, N.
D. (2021). Perspective: plant-based eating pattern for type 2 diabetes prevention and treatment:
efficacy, mechanisms, and practical considerations. Advances in Nutrition, 12(6), 2045-2055.
▪ Koloverou, E., Panagiotakos, D. B., Georgousopoulou, E. N., Grekas, A., Christou, A.,
Chatzigeorgiou, M., ... & ATTICA Study Group. (2016). Dietary patterns and 10-year (2002-
2012) incidence of type 2 diabetes: results from the ATTICA cohort study. The review of dia-
betic studies: RDS, 13(4), 246.
▪ McMacken, M., & Shah, S. (2017). A plant-based diet for the prevention and treatment of type 2
diabetes. Journal of geriatric cardiology: JGC, 14(5), 342.
▪ Pollakova, D., Andreadi, A., Pacifici, F., Della-Morte, D., Lauro, D., & Tubili,
C. (2021). The impact of vegan diet in the prevention and treatment of type 2 diabetes: a system-
atic review. Nutrients, 13(6), 2123.
▪ Schiattarella, A., Lombardo, M., Morlando, M., & Rizzo, G. (2021). The impact of a plant-based
diet on gestational diabetes: a review. Antioxidants, 10(4), 557.
▪ Satija, A., & Hu, F. B. (2018). Plant-based diets and cardiovascular health.
Trends in cardiovascular medicine, 28(7), 437-441.
▪ Toumpanakis, A., Turnbull, T., & Alba-Barba, I. (2018). Effectiveness of plant- based diets in
promoting well-being in the management of type 2 diabetes: a systematic review. BMJ Open Di-
abetes Research and Care, 6(1), e000534.
13
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“Role of Sustainable Plant Based Diet for the prevention

and treatment of Diabetes Mellitus”

Partial fulfillment of requirement for the award of Degree of

Clinical Nutrition & Dietetics

Dr. Kanchan Goswami

School of Biomedical Sciences GALGO-

TIAS UNIVERSITY UTTAR

Guide Division Chair

Dr. Kanchan Goswami

School of Biomedical Sciences School of Biomedical Sciences

This thesis/dissertation/report entitled ROLE OF SUSTAINABLE PLANT BASE DIET

Date: 4 may 2024

4. Specification regarding thesis format have been closely followed.

6. The thesis has been prepared without resorting to plagiarism.

7. All sources used have been cited appropriately.

8. The thesis has not been submitted elsewhere for a degree.

(Signature of the student)

Name: Drishti Bajaj

Roll No.: 22SBBS2060006

Approval sheet iii

Statement of thesis preparation iv

Table of Contents v-vi

List of Tables vii-viii

List of Figures ix-x

CHAPTER1: INTRODUCTION 9-18

CHAPTER 2: REVIEW OF LITERATURE CHAP-

TER 3: MATERIALS AND METHODS

1. POPULATION AND SAMPLE

5. DATA COLLECTION METHODS

6. STATISTICAL ANALYSIS PLAN

Table 2: medication: prescribed

Table 3: diet prescribed for renal calculi and T2DM

Table 4: diagnostic tests of LRTI and T2DM

Table 5: medication prescribed

Table 6: diet prescribed for LRTI and T2DM

Table 7: diagnostic test for urosepsis and T2DM

Table 8: medication prescribed

Table 9: diet prescribed for urosepsis and T2DM

Table 10: diagnostic tests for acute hypertension and T2DM

Table 11:medication prescribed

Table 12: diet prescribed for acute hypertension and T2DM

Table 14:medication prescribed

Table 17:medication prescribed

Table 19: diagnostic tests for AFI and T2DM

Table 20:medication prescribed

Table 21:diet prescribed for AFI and T2DM

Table 22: diagnostic tests for age and t2dm

Table 23:medication prescribed

Table 24:diet prescribed for age and t2dm

Table 25: diagnostic tests for acute stroke and T2DM

Table 26:medication prescribed

Table27: diet prescribed for acute stroke and T2DM

Table 29:medication prescribed

Table 31: diagnostic tests for CAD and T2DM

Table 32:medication prescribed

Table 34: diet prescribed for CAD and T2DM

Table 35: diagnostic tests for osteoporosis and T2DM

Table 36:medication prescribed