Diet & Diabetes

1. Diet & Diabetes Grace Neal (RD) Diabetes Dietitian

2. Nutritional Intervention • Help patient to make appropriate food choices to: - reduce risk - Improve glycaemic control - quality of life. • Advice needs to be based on scientific evidence and then tailored specifically for the individual, taking into account their personal and cultural preferences, beliefs, lifestyle and the change that the individual is willing and able to make.

3. No magic wand

4. Guidance Used • Evidence-based nutrition guidelines for the prevention and management of diabetes – May 2011, Diabetes UK • Hertfordshire Diabetes Clinical Guidelines – July 2010 • NICE Guidance GC66 – Type 2 Diabetes • NICE Guidance GC15 – Type 1 Diabetes • Diabetes UK

5. Management & Models • Everyone with diabetes should receive individual, ongoing nutritional advice from a registered dietitian (A) • All people with diabetes should be offered structured education at the time of diagnosis with an annual follow-up (A) • Education should involve a person-centred approach & a variety of learning styles (A)

6. TYPE 1 • Foods that have a direct impact on BGL’s and how to identify them(carbohydrate is the main nutritional consideration for glycaemic control) • Carbohydrate awareness and/or counting • Count the carbs to either match the insulin (fixed dose) OR adjust the insulin to match the carbs (basal bolus/MDI) • Awareness of: Exercise, Sickness, Alcohol and snacking etc. • General healthy eating advice in line with the population • DAFNE course (Dose Adjusting For Normal Eating)

7. Type 2 – Glycaemic control • Weight management should be the primary nutritional strategy in managing blood glucose (BG) in people who are overweight or obese • Focus should be on total energy intake rather than the source of the energy in the diet • The total amount of carbohydrate consumed is a strong predictor of glycaemic response & monitoring total carb intake is a key strategy in achieving glycaemic control • Physical activity!! & ?Lower GI food choices

8. Type 2 – CVD (blood lipids & blood pressure) • Saturated Fats & Trans fats • Plant sterols & stanols • Reduce sodium • Mediterranean style diet • Oily fish • Weight loss • Exercise (aerobic)

9. Educate about food/ food groups that have a direct impact on blood glucose levels Identifying carbs & understanding their relationship to glucose - Menus, diet history - Food & carb diary - Food pictures & models - Games Educate about foods/ diet types that will have a long term impact on BGL’s (abdominal obesity) Identifying high calorie & high fat foods/drinks - Diet history - Calorie counting - Food portion pictures - Games Type 2 – Practical2 Pronged Approach

10. Menu 1 Breakfast 2 x slices of thick wholemeal toast 2 heaped tsp jam Lunch 250 gram jacket potato ½ can of baked beans 125ml of low fat yogurt Snack 1 digestive biscuit Large green apple Dinner 150 gram chips 2 scoops of vanilla ice cream Menu 2 Breakfast Bowl of muesli Semi skimmed milk 150mls fresh orange juice Lunch Baguette Packet of baked crisps Snack Hot buttered scone Dinner 225g cooked spagetti 2 cream crackers Small pots of raisins Carbohydrate Awareness

11. Example of a patients ‘Food, Carb & BG’ diary

12. Example of a patients ‘Food, Carb & BG’ diary

13. It’s a way of finding out more about type 2 diabetes - Understanding the nature of their diabetes - The possible risks associated with having diabetes - What they can do to manage their diabetes and minimise any risks - Answers to most of the questions about their diabetes with which they may have • It’s a resource to help people manage the changes diabetes will bring to their life • It’s an opportunity to meet & share experiences with others • Different approach to education the patients are expected to be very much involved e.g. - They are asked lots of questions, they are encouraged to explore the answers themselves, often their questions will not be answered directly instead they are guided to work out the answer themselves OR to know how to find the answer

14. 2 x ½ day sessions • Newly diagnosed Type 2 diabetes (6/12) • 10 people in the group • 2 local DESMOND educators • Evidence based information about the causes, effects and options for managing diabetes

15. Summary • Type 1 - Carbohydrate & Insulin education (1-1 or DAFNE) - Food in relation to: hypo’s (tx), exercise etc • Type 2 - Weight Loss (if overweight or abdo obese) - Carbohydrate awareness (food & BGLs) - Healthy eating i.e. ↑vegetables, ↓ fat, moderate carb portions & opt for starchy carbs. - CVD: ↑oily fish, ↓ fat & opt for mono fats, ↑ lentils pulses, ↑ grains - ↑ Activity

16. What can you do? • Don’t try to be too specific!! Why? • Be careful of ‘rigid’ blanket advice!! Why? • ? Eating to prevent hypoglycaemia? Valid?? • Diabetes UK – “10 Steps to Healthy Eating” • ↑Activity e.g. GP referral scheme, local walk • ↓Sat Fat, ↓Sugary foods ↑Vegetables • Eat Well Plate OR Weight Loss Plate

17. What can you do? • Eat Well Plate • Weight Loss Plate

18. Contacts & Referrals • Ask GP to refer OR refer directly to service by: www.hertschs.nhs.uk - Type “SPOC Form” into search box (top left of page)

19. Contact & Referrals • Diabetes Service: Potters Bar Community Hospital Barnet Road Potters Bar Hertfordshire EN6 2RY Tel: 01707 621152 Fax: 01707 621178Email: Hertscommunitydiabetes@nhs.net • Dietitians direct: 01727 866600