Diabetes

Current nutritional and weight management guidance for people living with Type 1 diabetes is the same as for the general population. Food choices are not restricted simply due to a diagnosis of Type 1 diabetes, and Type 1 diabetes is not caused by lifestyle factors, including either bodyweight or physical activity level.

People living with Type 1 diabetes who inject insulin using multiple daily injections (MDI) or use an insulin pump are offered education to count the carbohydrate content of their food & drink and adjust their insulin doses accordingly. This provides the freedom to make unrestricted food choices, similar to the general population. All people living with Type 1 diabetes are eligible to attend Medway Intensive Type 1 Education (MINT1E) where they can learn these skills; if you would like to refer a patient, please see the “How to Refer” information further down this page.

For those people living with Type 1 diabetes on fixed insulin regimens (such as some housebound patients given insulin by our community nursing teams), consistent quantities of carbohydrates are recommended on a day-to-day basis.

Diabetes UK provides patient-centred nutrition guidance for people living with Type 1 diabetes here.

The key lifestyle focuses for Type 2 diabetes prevention are to maintain a healthy weight, eat well and be active.

Recommendations for those at risk of developing Type 2 diabetes:

For overweight/obese patients: Aiming for at least 5% weight loss

Reducing overall energy (calorie) intake, total fat and saturated fat intakes

Increasing fibre in the diet and physical activity levels

Adopting a dietary approach associated with risk reduction, such as:

Mediterranean diet, DASH diet, vegetarian and vegan diets, the Nordic healthy diet or a moderate carbohydrate restriction diet

Including wholegrains, some fruit, plenty leafy vegetables and cheese, tea and coffee

Reducing foods associated with increased risk such as red and processed meat, potatoes, particularly French fries, sugar sweetened beverages and refined carbohydrates.

Aim for at least 150 minutes per week of moderate to vigourous physical activity, over at least three days.

Diabetes UK provides patient-centred nutrition and lifestyle guidance for people at risk of Type 2 diabetes here.

There is a useful information prescription leaflet, from Diabetes UK, for any healthcare professional supporting patients with lifestyle changes to reduce their risk of Type 2 diabetes here.

Please also see here for diabetes prevention programme referrals in Medway; the NHS England’s Digital Weight Management Programe; and the “Medway Overweight and Obesity Care Pathway” for more on diabetes prevention.

Guidance for people living with Type 2 diabetes, from a lifestyle perspective, is generally the same as for diabetes prevention (above) and focused on maintaining a healthy weight, eating well and being active. There are a few differences:

Recommendations for those living with Type 2 diabetes:

For overweight/obese patients: To improve blood glucose levels and reduce the risk of cardiovascular disease, aim for at least 5% weight loss by reducing calorie intake and increasing physical activity.

If seeking to achieve remission of Type 2 diabetes, in overweight/obese patients aim for weight loss of approximately 15kg, as soon as possible after diagnosis. Please note, rapid weight loss and very low energy diets (VLEDs) should only be recommended with appropriate supervision from a dietitian or qualified healthcare provider and certain medications may need to be reduced or stopped prior to commencement. There is a trial programme for VLEDs currently underway in Medway, so please get in contact if you would like further information for a patient.

If appropriate, support people to identify and quantify their carbohydrate intake, encourage low glycaemic index (GI) foods and consider reducing the total amount of carbohydrates.

Diabetes UK provides patient-centred nutrition and lifestyle guidance for people living with Type 2 diabetes here.

There is a useful information prescription leaflet, from Diabetes UK, for any healthcare professional supporting patients who are considering significant weight loss to achieve the remission of Type 2 diabetes here.

Please also see the NHS England’s Digital Weight Management Programe; and the “Medway Overweight and Obesity Care Pathway” for more options regarding weight loss and lifestyle change.

Further information

For further information, please contact our specialist dietitian via the team email address.

We accept referrals that meet one of the following criteria:

Type 1 diabetes

• Newly diagnosed Type 1 diabetes
• Type 1 diabetes and emotional distress
• Technology initiation or support (e.g. FreeStyle Libre)
• HbA1c >65 mmol/mol
• Sudden rise in HbA1c >20 mmol/mol
• Frequent hypoglycaemia / hypo unawareness
• Frequent unexplained hyperglycaemia with/without ketones
• Pre-conception advice
• Enrolment in Type 1 structured education

Type 2 diabetes

• HbA1c >65 mmol/mol on maximum oral therapies
• Complex needs, e.g. renal replacement therapy
• Steroid induced hyperglycaemia
• Complex dietary needs (that do not fit local weight management programmes)
• Pre-conception advice
• Do not refer for Type 2 structured education (see “How to refer” below)

Other

• Pancreatic insufficiency affecting blood glucose
• Rarer types of diabetes (e.g. MODY)
• Unsure which type of diabetes