Mrs. Williams, 55 y/o female with 5 years of Type 2 DM and 20 years of HTN. Never smoked, drank alcohol, or used drugs. She weights 200 lbs with a BMI of 38. Her blood sugar is higher than the target value for the pass 3 months. Her blood pressure is well controlled on medication. Her total cholesterol is 240 and her HDL is 40. Her physician recommended on taking statin but she doesn’t want to because she heard bad things about statin drugs. Her goals are to loss weight, to better manage her glucose and cholesterol level.

Mrs. Williams realizes she needs to make changes and live a healthier life after knowing her sister just had a heart attack. She enjoys cooking but don’t have a lot of time to cook. She can walk on level ground and up one flight of subway stairs. Experienced shortness of breath if there is more than one flight. As a kid she enjoyed riding her bike and she liked to dance when she was young.

Nutritional Rx:

• Only getting sugar-free coffee from the cart outside the office and replace donut with less sugary options, such as whole-wheat bread
• On weekends, replace bacon with fresh fruits such as apple slices or berries. Avoid syrups
• Do meal-prep on weekends or on days when you have more free time. Use olive, canola, soybean or corn oil when cooking at home. Try to bring lunch to work as much as possible
• Instead of getting pizza or McDonalds, look for healthier options around work for lunch.
• Get salad kits from supermarket and use low-fat dressing
• Getting chicken from the market is a good choice of protein. Try to get some fish or lean cut meat next time. When choosing sides, get beans or vegetables and avoid starchy vegetables like potatoes
• Cut down on snacking in the afternoon gradually. Eating cookies or chocolate bar no more than twice a week to start with. Try fresh fruit, low fat yogurt or nuts for snack

Exercise Rx:

• Riding bike or playing soft ball with grandchildren on weekends or during the evening as much as you can
• Taking light walks to begin with. Try to walk for 15 minutes after dinner at least 3 times a week. On the days when you have cookies for snake, try to walk a little longer (20-30 minutes)
• Sign up for dance class with a friend and encourage Mr. Williams to join
• Follow up with the patient 3 month later to check for blood sugar and cholesterol level and weight loss