Julie is a 55year old woman with mild mental retardation. She lives in an independent support living

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Julie is a 55year old woman with mild mental retardation. She lives in an independent support living arrangement and she works at a bakery in a supported employment arrangement. She weighs 205 pounds and was recently diagnosed with diabetes. Her doctor recommended that she reduce the amount of sugar in her diet, lose weight and monitor her blood sugar five times a day.

Julie attended a six-week course recommended by her doctor on diabetes in which she was instructed on how to monitor her blood sugar. Julie's goal is to monitor her own blood sugar twice a day and report it on a chart that is monitored by her residential staff. However, when the staff goes to visit her, they usually find that there is nothing on the chart. Her staff usually responds by going over the steps for checking her blood sugar with her. They then have her check it and record it while they are there. Several times, Julie has become angry and thrown the glucometer across the room. On some of these occasions, her staff has had to leave without her blood sugar being checked. Frequently, Julie's blood sugar is too high when she checks it with her staff present.

In the six-week course, Julie also learned how to administer her own insulin shots.

At first, Julie did not like the idea of giving herself shots, but she has learned how to it. Occasionally, Julie forgets to take her insulin when she needs it. She is supposed to take an insulin shot before every meal.

Julie's favorite food is chocolate. She likes to buy a chocolate donut or an éclair during her work break. After work, she likes to walk down the street to the convenience store and buy a Coke. On the weekends she likes McDonald's for a Chicken McNuggets meal deal. Julie has always picked out her own food at the grocery store. She really likes potato chips and ice cream. She buys these items every week.

Julie's doctor has recommended that she lose weight. If she did lose weight, she might have better control over her diabetes. Julie says that she is interested in losing weight, but has not yet made any efforts to change her diet. Her support staff thinks that she may not know what foods contribute to maintaining her high weight and what type of changes would help her reduce her weight.

Julie has never been involved in regular exercise. Her only regular exercise is her walk down the street to the convenience store and her two-block walk from the bus stop to the bakery where she works. One of the activities she does like is going to parks.

Anything that involves outside seeming to be fun for her.

1-What is the behavior that you want to be changed?

2-What health promotion actions would help?

3-Think about the above issues and prepare a Plan using the attached materials.