At over 6ft, Ronda carries her 240 pounds reasonably well, but still not surprising that in this fourth pregnancy, she screens positive for diabetes. Her other pregnancies have gone well, so she finds it hard to get serious about this. Not well controlled on a moderate dose of insulin, I ask her to keep a diet diary--everything she eats over three days.
She must have found a smart phone ap because she brings in a computer print-out, initially impressive though short on details (more of what she ate than how much):
1. Fast food ("I don't have time, I work, I take care of my family, I get up at 4 to drive my boyfriend to work."). Okay, grant a hectic schedule. leaving little time for food preparation.
2. No fruits or vegetables ("I don't like salads; maybe broccoli with cheese; or if I have my thousand island dressing").
3. Sugar soda ("I hate diet drinks--all of them").
Any suggestion I made was immediately countered--she's been through this discussion before. Best I could do was an agreement to mix regular with diet soda, slowly increasing the ratio of diet to regular.
From 59-yr old Teresa, when asked the usual screening questions about depression and safety at home: "I feel safe at home and I don't feel in any danger. I know that he's not in good health, and he's just getting grumpier and becoming more stubborn as he gets older."
