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Diabetes - Dietary and Lifestyle Recommendations
Diabetes - Dietary Recommendations

Glycaemic Control

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Glycaemic Control

Dietary Advice for Type 1 Diabetics

Referral to a Diabetes Specialist Dietitian is essential to provide individually tailored diabetes dietary advice to those with type 1 diabetes.

Dietary advice is based on the Eat Well plate and encompasses cardio protective advice.

The amount of carbohydrate in meals and snacks has a much greater influence on blood glucose and overall glycaemic control than the source or type.

Optimal glycaemic control requires insulin to be matched to lifestyle, meal patterns and total carbohydrate intake.

This may be done using a system of carbohydrate counting for those on multiple dose injections or continuous subcutaneous insulin infusion. Education should be offered to support this.
Consistent quantities of carbohydrate on a day-to-day basis are beneficial for those people on fixed insulin regimens.

Simply changing to low sugar or low glycaemic index foods is not enough to control blood glucose in those with type 1 diabetes.

The need for in between meal carbohydrate snacks depends on, body weight, individual preference and insulin regimen.

Review of carbohydrate intake and distribution is needed in cases of unexplained episodes of hypoglycaemia or hyperglycaemia or wide fluctuations in blood glucose.

 

Dietary Advice for Type 2 Diabetics

For newly diagnosed adults, first line advice should be given in primary care.

  See - A4 Food Choice and Diabetes Leaflet
  For annual dietetic review
  Annual review can be given in primary care. See recommendations in the local dietetic competencies statement
  See - Dietetic Competencies Statement
  See - Competencies Checklist

The majority of the newly diagnosed benefit from referral to the local structured Education- DESMOND

 

See - DESMOND Referral Forms & Pathways

Individual Referral to a dietitian should be considered according to local guidance.

 

See - Dietetic Referral Forms & Pathways

Consider the following when giving dietary advice:

 

Age

 

Other medical conditions

 

BMI, waist circumference

 

Cultural and social/personal factors

Weight loss in the overweight / obese BMI categories improves glycaemic control. The main requirement of a dietary approach to weight loss is that total energy intake should be less than energy expenditure rather than the macronutrient composition.

The total amount of carbohydrate consumed is a strong predictor of glycaemic response and monitoring total carbohydrate intake is a key strategy in achieving glycaemic control. For this, various strategies can be used in combination of calorie balance principles.

A sugar–free diet is neither practical or evidence based. Sucrose does not increase blood glucose more than the equivalent amount in carbohydrate such as bread. Small amounts of sweet foods, in solid form may be included in the diet.

There may be other health reasons for further restriction of sugars such as hypertriglyceridaemia dental health and in weight reduction.

Optimal glycaemic control requires appropriate diabetic treatment to be matched to lifestyle and food intake.

Diets based on food with a low glycaemic index can improve glycaemic control, insulin resistance, lipid profiles and fibrinolysis.

Physical activity on a regular basis benefits glycaemic control, particularly in those with insulin resistance.

Dietary advice for Type 2 diabetes is based on the Eat Well Plate and should encompass cardio protective principles.

 

Advice for those with Low Body Mass Index

Care should be taken with advocating sweeping dietary changes in those with lower BMI’s so as not to cause an individual to become malnourished. If in doubt contact a dietitian for advice.

 

Insulin Treated Type 2 Diabetes

Weight gain is associated with the commencement of insulin in this group and is more usually a problem for those who are already obese.

Discuss appetite and weight control before commencing insulin.

The need for between meal snacks is reduced in those who already obese as mid meal and night hypoglycaemic is less likely.

The recommendation on carbohydrate intake and distribution varies according to insulin regimen.

Referral to a dietitian is recommended.

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Useful External Links & Resources

View

Eat Well Plate

PDF File

A4 Food Choices and Diabetes

PDF File

Dietetic Competencies Statement

PDF File

Competencies Checklist

PDF File

Dietetic Referral Forms (N Beds)

PDF File

Dietetic Referral Forms (S Beds)

PDF File

Dietetic Referral Criteria and Location of Service (N Beds)

PDF File

Dietetic Referral Pathways (S Beds)

PDF File

Dietetic Referral Pathways (Luton)

PDF File

Luton Community Diabetes Referral Form

PDF File

DESMOND Referral Forms (N Beds & S Beds)

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