Diet

1
Diet Diabetes

• Lynn Sawyer
• Specialist Dietitian
• North Bristol NHS Trust
• 18th March 2009

2
Diet Diabetes

• Obesity and diabetes management
• Common problems people
• using insulin encounter

3
Obesity

• Where do calories come from
• how to make lower calorie choices

4
Eating not just about energy

• Why do people eat?
• What do people eat?
• How to motivate change

5
Jane

• 32 yr old women, T1 for 25 yrs
• Planning pregnancy
• 3yr old delivered at 27 wks gestation for
  pre-eclampsia, booking HbA1c 12.2
• Current HbA1c 9.5
• Complications frequent hypos nocturnal hypos
  GI involvement HT eGFR 42

6
Jane

• What needs to be considered before she becomes
  pregnant?
• What other investigates would you suggest?
• Looking at her food diary what would you advise
  her?
• How would you suggest she treats her hypos?
• In the long term, how would you suggest she
  manage her diabetes?

7
Hypos

• Hypos, good agreement for treating BG lt4mmol/L
  (ADA 2008, DUK Website accessed 04/11/08)
• Symptoms (Deary in Frier Fisher 1999)

8
Evidence

• Treatment
• Ingestion of 15-20g glucose
• Response apparent in 10-20 mins
• Pure glucose preferred treatment (faster than
  orange juice/milk)
• Glycaemic response correlates better with glucose
  content than carb content
• 10g glucose raises plasma glucose by 2.2mmol/L
  over 30 mins
• 20g glucose raises plasma glucose by 3.3mmol/L
  over 45 mins
• Initial dose of 20g reasonable should be
  repeated in 15-20mins
• After BG gt4mmol/L 10-20g of slower-acting
  carbohydrate
• (ADA 2008 2003, DUK 2003, Cryer et al 2003)

9
NBT advice
10
Discussion