Posted on 11 Mar 2017 Views 4474 Comments 19

Considerations for people with diabetes

It’s a well-known fact that obesity accounts for 80–85% of the risk of developing type 2 diabetes. Because of this, it’s no wonder several of our clients have type 2 diabetes. Studies suggest that 75% of type 2 diabetics are on some form of medication or insulin (Sharma et al, 2016); the degree of medication tends to increase with disease progression over time. We thought it would be useful to provide some information about key considerations (such as for medication) for people with diabetes who are following (or considering starting) a Slim & Save programme. This article also highlights some of the new and upcoming research suggesting the role of very low calorie diets (VLCDs) in the treatment of type 2 diabetes.

This article refers to type 2 diabetes (which accounts for around 90% of people with diabetes). Type 2 diabetes is different to type 1 diabetes which is an autoimmune disease often diagnosed in childhood, and requires insulin treatment from the outset. Our programmes are not suitable for people with type 1 diabetes.

Consult your Doctor before commencing Slim & Save

diabetes checkRegardless of how your diabetes is treated, it’s of paramount importance that every customer checks with their GP that their Slim & Save plan is suitable for them. We ask every first time customer to sign a declaration confirming that they have consulted with their GP via a health questionnaire before placing their first order. It’s also really important that you seek regular supervision whilst following our programmes – this may be through your diabetes healthcare professional (e.g. practice nurse) or you GP if you have other medical history that may be a concern to the safety of following a VLCD (e.g. gallstones or gout).

Medication considerations

There are a large range of medications which a diabetic may be prescribed. Metformin and sulphonylureas are the most commonly prescribed oral diabetes medications for the first-line treatment and add-on therapy for diabetes, with metformin accounting for 90% of prescriptions for newly diagnosed diabetics needing medication. Insulin is prescribed to around 20% of type 2 diabetics. You should ensure you have a full medication review with your GP before starting a Slim & Save programme. We have included some particular information regarding some of the common medications which you may be taking:

  • Sulphonyureas, e.g. gliclazide, glibenclamide, glipizide, tolbutamine - following a VLCD significantly reduces blood sugars independently of weight loss (due to the minimal intake of carbohydrate experienced on the plan), meaning hypoglycaemia (‘hypo’) is likely to occur if these medications are not reduced or stopped. Discuss your medication and blood sugars with your GP or diabetes specialist nurse before commencing Slim & Save; they will probably ask you to monitor your blood sugars more frequently, in the early days at least, in order to assess the affect that following the VLCD has on your blood sugar control and the degree at which the medication dose might need to be reduced.

  • Insulin - following a VLCD significantly reduces blood sugars independently of weight loss, meaning hypos are likely to occur if insulin is not reduced or stopped. Discuss with your GP or diabetes specialist nurse before commencing Slim & Save; they will probably ask you to monitor your blood sugars more frequently, in order to assess the affect that following the VLCD has on your blood sugar control and the degree at which the insulin dose might need to be reduced.

  • Hypos are very unlikely if you take metformin only, so taking metformin should not affect your ability to safely follow the programme. You should continue taking your usual dose unless advised otherwise by your healthcare professional or GP.

  • Other diabetes medications, such as thiazolidinediones (glitazones) and incretin mimetics (GLP–1 agonists), e.g. exenatide are unlikely to cause hypos when used alone, but may cause risk of hypos when combined with other diabetes medications like sulphonylureas (Rizos et al, 2009; Chaplin & Bain, 2016).

Many people who are overweight or obese and/or diabetic will also be on blood pressure medications (anti-hypertensives). Losing weight, as seen when people follow our programmes helps to reduce blood pressure. Evidence suggests that a 5.1kg (11lb) weight loss results in a reduction in systolic pressure (top number) of 4.44 and diastolic pressure (bottom number) of 3.57. This works out as a blood pressure drop of approximately 1 mmHg for every kilogram (2.2lbs) lost (Neter et al, 2013). As a result, people often need their medication reduced as their blood pressure reduces. It is important be have regular checks with your GP to assess this. If you’re on diuretics, your GP may wish you to stop these before commencing the programme.

There are many medications which can normally continue to be used by people on a VLCD without any effects. These include antibiotics, anti-emetics (anti-sickness), antacids, oral contraceptives and anti-histamines. However, we do advise you to double check all medications with your GP before starting a programme.

New Research

It has always been thought that type 2 diabetes is incurable. However, there is emerging evidence to suggest that diabetes could be reversed by following a VLCD. Here are some key pieces of research that have been published over the last few years:

  • Researchers at Newcastle University found that 7 out of 11 obese patients with diabetes who drastically cut their calories to 600kcal/day for two months (whilst following a VLCD) remained free of diabetes three months later (Lim et al, 2011).
  • Researchers at Leiden University in the Netherlands found that obese patients who followed a VLCD restricting them to 500kcal/day for four months were able discontinue all their insulin injections, and 75% remained insulin-free for more than a year even when they returned to ‘normal’ diets afterwards (Hammer et al, 2011).
  • A very recent study (Cheng et al, 2017) has suggested that the pancreas (the organ responsible for producing insulin) could be regenerated by following a period of fasting (on a form of VLCD) by a period of ‘normal eating’. It’s important to note that this study used mice, and animal data cannot be translated to human evidence. More studies are required to look at whether a similar effect in seen in humans.

What support is available to you?

At Slim & Save we pride ourselves with our customer care, and our customer care team are happy to answer any questions you may have, or point you in the right direction of who you should contact. At Slim & Save, we also try to encourage all members who have reached goal to stay in touch and continue to get support either through the forum or through Facebook, email, live chat etc, so we can motivate everyone to stay at goal weight and lead a healthy lifestyle in the future.

References

  • Chaplin, S. and Bain, S. (2016). Properties of GLP–1 agonists and their use in type 2 diabetes. Prescriber. Available at http://onlinelibrary.wiley.com/doi/10.1002/psb.1430/pdf (accessed 21st February 2017).
  • Cheng, C. et al (2017). Fasting-mimicking diet promotes Ngn3-driven b-cell regeneration to reverse diabetes.Cell. 168 (5): 775–788.
  • Hammer, S. et al (2011). Sustained improvements in left ventricular diastolic function induced by weight loss are associated with a decrease in pericardial fat content in patients with type 2 diabetes mellitus. RSNA.
  • Lim, E.L. et al (2011). Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 54 (10): 2506–2514.
  • Neter, J.E. et al. (2003). Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 42 (5): 878–884.
  • Rizos, C.V. et al (2009). How safe is the use of thiazolidinediones in clinical practice? Expert Opinion on Drug Safety. 8 (1): 15–32.
  • Sharma, M. et al (2016). Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study. Diabetes and Endocrinology Research.
Written by Annemarie Aburrow RD BSc (Hons) PGDip, Slim & Save Dietitian.

We want your feedback!

Answer the following question in the comments, below, and our favourite answer will win a £50 Amazon Voucher. Entries close Monday 20th March at 4pm.

Do you think that with the latest research showing that VLCD’s can reverse type 2 diabetes that it helps take away the stigma that a VLCD Meal Replacement Diet is a “Faddy” diet? Do you have friends and relatives who try to put you down for following a VLCD and think that its a gimmick diet etc, do you feel this enforces how effective a VLCD can be?

Comments on Considerations for people with diabetes
Helen Hillman 13/04/2017 17:19
Excellent article with really helpful info . Thank you also for the distinction between type 1 and type 2 diabetes. As the mother of two type 1 children i know how important it is to be aware that type 1 cannot be cured by diet.
Andrea Ilies 31/03/2017 13:40
Great article and very helpful !
Jennifer Goodall 28/03/2017 08:22
A really interesting read and fantastic comments from our members.
Rebecca Westwood 19/03/2017 18:07
The first time I started SnS I was on Metformin - the combination made me so ill (upset tummy) that I stopped taking the pills which was really naughty, but after only a month on this diet my blood sugar was back to normal, my doctor agreed that if I kept my blood levels the same I didnt need to take the medication. A VLCD can definately reverse Type 2 diabetes, it can also improve lots of other conditions, blood pressure, cholesterol etc. It is hard to start off with but once you get into the right routine it becomes a way of life - and an added bonus of making you healthier, quicker.
Sharon Brooke's 16/03/2017 13:52
I started slim and save in may last year, at which point I was having four metformin a day and two doses of 68 units of slow acting insulin and 3 doses of 28/30 units slow acting insulin and an extra jab of victosa and my blood sugars were still climbing I am type 2 diabetic, with in 3 months I think it was I was taken off of all diabetic meds and all because of slim and save they as good as saved my life because I was heading down the wrong road I was 24st 5lb I am now 18 stone and still plodding along its not easy and I do have blips but I know this is for life for me it doesn't matter how long it takes me I will get to my goal weight.... The slim and save staff are amazing the support they give is second to none x
Laura Carle 16/03/2017 13:29
The latest research definitely takes away the stigma that being on a VLCD diet is faddy. I think when people find out you're doing a VLCD they poo poo it as not being safe but arming them with this information I think will make them think twice.
Being on a VLCD makes you so much more aware of your eating habits and I firmly believe that no matter how you lose it, it's how you maintain it. If you don't change your eating habits then you will inevitably put the weight back on.
Kerri-lei card 15/03/2017 21:59
My sister started S&S in January she is over 2 stone down and she had type 2, plus high blood pressure, and a load of other things, anyway last week she went back and her pressure is now excellent her diabetes is now excellent and she is just waiting on test results this week to see if she can come off all her tablets.
Kirsty Crane-Bentley 15/03/2017 19:02
I was diagnosed with type 2 diabetes last year and slim and save helped me get my blood sugar levels down so much it meant I no longer had it. After bloods and a doctors visit yesterday I am a diabetic again! So I am currently on day 1 of SnS again to beat it for a final time.
I too have friends and family that make comments about the way in which I have chosen to lose weight and how I will not maintain my goal weight once achieved. I always responded with "it works for me so I will continue! And maintaining my weight loss is my responsibility so do not worry yourself and can be done if done correctly". My daughter on the other hand, who is 10, is so supportive and even helps me plan and prepare our meals.
Overall I think VLCD diets are a lot easier to follow than trying to diet on your own, all the measurements are already set so little prep is needed. Slim and Save are particularly good as they offer several means of support along with a tool/planner for maintaining.
All in all very good all round!
Leanne tetley 15/03/2017 18:43
My son is insulin dependant diabetic & also a personal trainer. He has tried to deter me from doing this diet but I can no longer go to the gym to do the weights and cardio I used to do to keep my weight down due to a bad car accident. I've piled 5 stone on and I don't want to be diabetic as it's a strong gene in our family. So as I'm over 40 now I know I needed to get motivated and I think the lifestyle is great as it doesn't split the family routine up either. I AM going to lose this weight and get healthy & NOT be diabetic x
Vanessa Walker 15/03/2017 17:34
My sister and husband both tried to talk me out of starting 'another fad diet' yet within a few weeks I had started to achieve impressive results. But the best thing about a vcld diet is the way it forces you to look at your previous eating habits. I questioned my relationship with food and am changing the way I look at everything I eat. Food is now for sustenance rather than a treat or punishment. Sns has broken the emotional attachment I had with food.

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