Insulin treated type 2 diabetes

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Health Tips with Dr. Leeds Interview with Dr. Adrian Brown, Senior Researcher, Nutrition & Dietetics
https://www.youtube.com/watch?v=-nOC27FtEn8&t=390s

In this conversation Dr Adrian Brown describes a clinical trial in which people with type 2 diabetes who were treated with insulin injections and who had been diagnosed with diabetes on average 13 years previously, were offered usual care or a formula low energy diet (about 820kcal/d) for 12 weeks followed by 12 weeks of reintroduction of conventional food to achieve a weight maintenance diet for a total of one year.  He describes the main findings – those on the formula diet lost on average just under 10kg, while those following usual care (conventional dietary guidance) lost 5.6 kg. The control of blood glucose improved more in the formula diet weight loss group than in usual care, while four times more people (13 out of 45) were able to stop injecting insulin after the formula diet than after usual care (3 out of 45).  Overall insulin dosages fell in both groups but more so in the formula diet group (approximately 75%).  Quality of life improved in the formula diet group especially in those who no longer needed to inject insulin.

This landmark study showed for the first time that the same type of weight loss programme can be used in insulin treated people with type 2 diabetes as has been used in people earlier in the disease process treated only with diet and oral medications (described in episodes one and two of this series and with relevant weblinks given below).

Dr Brown emphasised that anyone treated with insulin who plans to lose weight must consult their doctor and specialist diabetes nurse.  Episodes of low blood sugar, one of the possible hazards in this type of diet programme, did occur in some people in both groups but was mild, not requiring any medical assistance. Blood pressure can be lowered by this type of diet and blood pressure medications must be carefully managed too.

People with type 2 diabetes who inject insulin cannot be ‘cured’ by this diet treatment but their body metabolism can be improved so that some can use less insulin, while others can stop altogether because they are still producing sufficient insulin of their own.  However, it is likely that with the passage of time (perhaps one or two years) or with weight regain, their need for insulin would require resumption of insulin injections.  This emphasises the importance of providing adequate support in maintaining the dietary changes, doing adequate physical activity, and providing sufficient medical monitoring.

More work needs to be done to establish how best to deliver this type of programme on a large enough scale for those who may need it, but it does provide some good clinical trial proof that this can be done.

Web links to useful sources of information are given below.

About Diabetes:

Diabetes remission:

https://www.diabetes.org.uk/research/research-round-up/research-spotlight/research-spotlight-low-calorie-liquid-diet

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Diabetes prevention:

The Canadian Diabetes Risk calculator:

The Indian Diabetes risk score:

UK Type 2 diabetes – know your risk

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