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Gradual weight loss is preferred — not more than 0. For effective weight loss and improvement in glycaemic control, the amount of energy restriction is more important than dietary composition, though compliance may be greater with high monounsaturated fat diets Figure Weight loss of as little as 4 kg will often ameliorate hyperglycaemia. Reduced-calorie diets result in clinically significant weight loss regardless of which macronutrients they emphasize….
Antiobesity drugs have so far played only a minor part in the management of the obese patient with diabetes. Sibutramine is a centrally acting serotonin and norepinephrine reuptake inhibitor that acts as an appetite suppressant. It has many contraindications, potential drug interactions and stringent requirements for monitoring, and little information on long-term efficacy and safety. Orlistat acts locally in the gastrointestinal tract, where it blocks enzymatic digestion of triglyceride by inhibiting pancreatic lipase. Gastrointestinal side effects are common, including flatulence, steatorrhoea and, occasionally, faecal incontinence.
A diet rich in fruit and vegetables is needed to avoid fat-soluble vitamin deficiency. Orlistat should be started only if diet alone has produced 2.
Tell Me What to Eat if I Have Diabetes, Fourth Edition: Nutrition You Can Live With
Orlistat may be helpful to prevent weight regain following a very-low-energy diet. The dietary recommendations are essentially the same for type 1 and type 2 diabetes and, indeed, follow a healthy eating plan suitable for the entire population Box Saturated fat should be reduced and replaced with monounsaturated fat such as olive oil or polyunsaturated fats.
Dietary cholesterol may be more detrimental in diabetics than in the general population, so the consumption of foods such as eggs should be limited. Fish oils are rich in n-3 fatty acids and have lower triglyceride levels, and there is evidence that higher fish intake is associated with less CVD in diabetes; accordingly, servings of fish per week are recommended.
Simple dietary guidelines in the form of recommended foods are normally best for patients, and are better understood than measures of fat, carbohydrate or protein. Sucrose need not be banned from the diabetic diet, and a moderate amount for sweetening is acceptable. Foods that normally improve glycaemic control and CVD risk are whole grains brown rice, wholewheat breads, oats and high-fibre foods grains, cereals, fruits, vegetables and nuts.
Box Several programmes have been developed in Europe and North America to educate patients about diabetes. An example in the UK for patients with type 2 diabetes is the diabetes education and self management for ongoing and newly diagnosed DESMOND structured education programme.
Clinical studies have shown that structured education programmes focused on behaviour change can successfully engage those with newly diagnosed type 2 diabetes in starting effective lifestyle changes that are sustainable. Exercise does not usually cause hypoglycaemia in type 2 diabetes in contrast to type 1 diabetes , and therefore extra carbohydrate is generally unnecessary. Resistance exercise, such as weightlifting performed times per week, may provide extra benefits over aerobic exercise; however, it should be done with proper instruction, progressively increased over some weeks, starting with a low-intensity workload and supervised.
How do the different dietary approaches for type 2 diabetes compare?
Overweight and obese patients are likely to be insulin resistant: here, the insulin sensitiser metformin is a logical first choice. Unlike sulphonylureas, it does not cause hypoglycaemia or weight gain and, indeed, has some appetite-suppressing activity that may encourage weight loss. A typical starting dose of metformin is mg daily or twice daily, rising to mg thrice daily. Major side effects are nausea, anorexia or diarrhoea, which affect about one-third of patients.
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