Lifestyle advice
You should provide individualised and ongoing lifestyle advice to all patients with type 2 diabetes; this should be in a form sensitive to the individual's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life.6
Dietary advice
Adopting a healthy, balanced diet plays a major role in the initial management of type 2 diabetes, aiming at weight reduction in obese patients. Some patients can be adequately controlled by diet alone but most will eventually require drug therapy.
Pharmacists are ideally placed to reinforce dietary advice and encourage the patient to reduce their consumption of fats and refined carbohydrate (sugars) and increase the ingestion of unrefined carbohydrate (starches) to about half of the daily energy intake. A wide variety of foods should be included in the diet particularly those with a high dietary fibre content. As well as being beneficial in a number of other ways, dietary fibre may slow the absorption of sugars from the diet.
Fruit, vegetables and unrefined carbohydrates should make up the bulk of a person's diet. Advise patients to choose brown and wholegrain carbohydrates and be sparing with high-fat additions such as cheese, cream and butter. Aim for a minimum of five portions of fruit and vegetables a day, and vary the type to get the maximum vitamins possible.
Special diabetic foods are not recommended as they may contain fructose, which has the same calorific content as sucrose or sorbitol, which can cause diarrhoea. Foods sweetened with saccharin or aspartame are more suitable for patients with diabetes.
Usually dietary management is used alone for the first three months then if the patient still has significant hyperglycaemia, drug treatment is instigated.
There should not be too many restrictions for a person with diabetes, it is about encouraging the patient to lead as normal life as possible. A diet that is high in polyunsaturated fats and fish oil, fresh fruits and vegetables should be encouraged. This healthy eating can also help to reduce the risk of developing type 2 diabetes.
The Food Standards Agency summarises the advice as:
Base your meals on starchy foods.- Eat lots of fruit and vegetables.
- Eat more fish - including a portion of oily fish each week.
- Cut down on saturated fat and sugar.
- Try to eat less salt - no more than 6g a day for adults.
- Get active and try to be a healthy weight.
- Drink plenty of water.
- Don't skip breakfast.
- Remember to enjoy your food!