Phcuk.org
Lower carb dietary option, Doctor/Nurse protocol Norwood GP Surgery: T2D, prediabetes, General point: Remember not all low carb diets are necessarily good, for example a diet coke and peperoni sausage diet is low carb, but not well formulated. A well formulated low carb diet will be full of fibre & essential nutrientsPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5aaW5uPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5aaW5uPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48UmVj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ADDIN EN.CITE.DATA [1]see The Norwood diet sheet At the first appointment:- Explore possible benefits/ risks of a lower carb approach to T2diabetes (eg medications risk of hypo) and make a start on motivation. The idea of diabetes remission or coming off meds is very motivating for many people.An example of the type of question you can ask.‘You have a range of different possible futures WRT to your diabetes, which will you choose?’ ‘Average weight loss on low carb is 9Kg is this of interest to you?’ etc..,?- Check are the patients interested in the low carb approach??-Visit basic physiology of sugar starting with the fact that 'your HbA1c shows how sugary your diet has been in the last few months’, and explaining sugar can almost be seen as a metabolic poison to someone with T2D.Ask ‘Where do you think the sugar has come from in your diet?’?? Explain dietary sources of glucose with sugar equivalence infographics ADDIN EN.CITE <EndNote><Cite><Author>David Unwin</Author><Year>2016</Year><RecNum>242</RecNum><DisplayText>[2]</DisplayText><record><rec-number>242</rec-number><foreign-keys><key app="EN" db-id="v0zfff527t0azne0f5bpf50fe5rwdfdapxrd" timestamp="1598889882" guid="7370fa25-bc24-4176-a1ab-5ca42c2545fe">242</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>David Unwin, David Haslam, Geoffrey Livesey,</author></authors></contributors><titles><title>It is the glycaemic response to, not the carbohydrate content of food that maters in diabetes and obesity: The glycaemic index revisited</title><secondary-title>Journal of Insulin Resistance</secondary-title></titles><periodical><full-title>Journal of Insulin Resistance</full-title></periodical><volume>2016;1(1), a8.</volume><number><style face="underline" font="default" size="100%">;[2] (shortlisted for a prize by NICE) ?Give the Norwood standard diet sheet for low carb approach.Establish baseline data; Wt., waist, height, bloods; HbA1c, renal, fasting lipids, FBC. ?Enter EMIS computer code ‘low carbohydrate diet’. -MedicationsThree risks to be aware of ADDIN EN.CITE <EndNote><Cite><Author>Murdoch</Author><Year>2019</Year><RecNum>107</RecNum><DisplayText>[3]</DisplayText><record><rec-number>107</rec-number><foreign-keys><key app="EN" db-id="v0zfff527t0azne0f5bpf50fe5rwdfdapxrd" timestamp="1598889860" guid="ce976bcd-bc99-477c-81f2-730d06c30c44">107</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Murdoch, C.</author><author>Unwin, D.</author><author>Cavan, D.</author><author>Cucuzzella, M.</author><author>Patel, M.</author></authors></contributors><auth-address>Wincanton Health Centre, Wincanton; chief medical officer, Digital Diabetes Media, Coventry, UK.
Norwood Surgery, Southport, UK.
London Medical, London, UK.
West Virginia University School of Medicine, WVU Center for Diabetes and Metabolic Health, Morgantown, US.
Medical School, University of Sheffield, Sheffield, UK.</auth-address><titles><title>Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide</title><secondary-title>Br J Gen Pract</secondary-title></titles><periodical><full-title>Br J Gen Pract</full-title></periodical><pages>360-361</pages><volume>69</volume><number>684</number><edition>2019/06/30</edition><dates><year>2019</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1478-5242 (Electronic)
0960-1643 (Linking)</isbn><accession-num>31249097</accession-num><urls><related-urls><url><style face="underline" font="default" size="100%">;[3]:Risk of hypoglycaemia (Insulin, gliclazide) reduce dose/stop but monitor Risk of DKA particularly with SGL2Inhibitors ADDIN EN.CITE <EndNote><Cite><Author>Murray</Author><Year>2021</Year><RecNum>488</RecNum><DisplayText>[4]</DisplayText><record><rec-number>488</rec-number><foreign-keys><key app="EN" db-id="v0zfff527t0azne0f5bpf50fe5rwdfdapxrd" timestamp="1612896867" guid="e7c04145-7a44-47fd-acd3-d13a390a3e2d">488</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Murray, Scott W.</author><author>McKelvey, Sean</author><author>Heseltine, Thomas D.</author><author>Henderson, George</author><author>Singh, Jagdeep</author><author>Unwin, David</author><author>Brady, Adrian J. B.</author></authors></contributors><titles><title>The “discordant doppelganger dilemma”: SGLT2i mimics therapeutic carbohydrate restriction - food choice first over pharma?</title><secondary-title>Journal of Human Hypertension</secondary-title></titles><periodical><full-title>Journal of Human Hypertension</full-title></periodical><dates><year>2021</year><pub-dates><date>2021/02/09</date></pub-dates></dates><isbn>1476-5527</isbn><urls><related-urls><url>;[4] in which case the DKA may be euglycaemic (normal blood glucose). Stop before starting the diet, monitor blood glucose and weight carefully. Risk of hypotension, explain that with weight loss BP may well improve and medications for this may be reduced or cut back ADDIN EN.CITE <EndNote><Cite><Author>Unwin</Author><Year>2019</Year><RecNum>324</RecNum><DisplayText>[5]</DisplayText><record><rec-number>324</rec-number><foreign-keys><key app="EN" db-id="v0zfff527t0azne0f5bpf50fe5rwdfdapxrd" timestamp="1598889898" guid="e07fba84-0fe2-4894-be6a-0653341cb026">324</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Unwin, David J.</author><author>Tobin, Simon D.</author><author>Murray, Scott W.</author><author>Delon, Christine</author><author>Brady, Adrian J.</author></authors></contributors><titles><title>Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care</title><secondary-title>International Journal of Environmental Research and Public Health</secondary-title></titles><periodical><full-title>International Journal of Environmental Research and Public Health</full-title></periodical><pages>2680</pages><volume>16</volume><number>15</number><dates><year>2019</year></dates><isbn>1660-4601</isbn><accession-num>doi:10.3390/ijerph16152680</accession-num><urls><related-urls><url>;[5]-Salt; Due to the renal sodium retaining properties of insulin ADDIN EN.CITE <EndNote><Cite><Author>Unwin</Author><Year>2019</Year><RecNum>324</RecNum><DisplayText>[5]</DisplayText><record><rec-number>324</rec-number><foreign-keys><key app="EN" db-id="v0zfff527t0azne0f5bpf50fe5rwdfdapxrd" timestamp="1598889898" guid="e07fba84-0fe2-4894-be6a-0653341cb026">324</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Unwin, David J.</author><author>Tobin, Simon D.</author><author>Murray, Scott W.</author><author>Delon, Christine</author><author>Brady, Adrian J.</author></authors></contributors><titles><title>Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care</title><secondary-title>International Journal of Environmental Research and Public Health</secondary-title></titles><periodical><full-title>International Journal of Environmental Research and Public Health</full-title></periodical><pages>2680</pages><volume>16</volume><number>15</number><dates><year>2019</year></dates><isbn>1660-4601</isbn><accession-num>doi:10.3390/ijerph16152680</accession-num><urls><related-urls><url>;[5] for those with T2D going low carb and therefore lower insulin results in considerable loss of sodium and consequently a diuresis. Patients may well need to increase their salt intake –particularly in the first few weeks of the diet. Those on diuretics may be able to stop them -Suggest a review date - often 2 or 4 weeks depending on assessed risks. Perhaps longer for pre-diabetes On reviewWeigh, measure waist, BP. Do medications need to be changed? See aboveHow is it going? Problems/suggestionsThree worrying patterns wrt HbA1c If both weight and HbA1c are climbing the most common reason is ‘carb creep’ NOT failure of the diet needing medication. So check for this by rechecking dietary intakes. Over time many patients drift. It’s better to see this as a learning opportunity. We all learn from our mistakes!Weight loss alongside a climbing HbA1c is worrying –ask a doctor about this. ? T1D, ?MalignancyHbA1c ‘too good’ eg. 28mmol/mol could the patient be anaemic? Produce Emis graphs of Wt., HbA1c etc. as feedback to maintain motivation.?Do they wish to continue?Are they happy to share anonymised data??If so enter Emis GP computer code 'obtaining consent'Would they like to attend the group sessions –do they know how to find out when the next one is??Next steps?Review date and agree next blood test (HbA1c etc.) -usually at 2 months from the start, but this depends on a risk analysis.Lipid profiles Fasting profiles are preferable as triglyceride/HDL ratios are a better predictor of risk than LDL Lipid profiles usually (but not always) improve on low carb ADDIN EN.CITE <EndNote><Cite><Author>Gjuladin-Hellon</Author><Year>2018</Year><RecNum>227</RecNum><DisplayText>[6]</DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="v0zfff527t0azne0f5bpf50fe5rwdfdapxrd" timestamp="1598889881" guid="c4ab638c-76b0-44bd-aa70-cdec3c73e6e4">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gjuladin-Hellon, T.</author><author>Davies, I. G.</author><author>Penson, P.</author><author>Amiri Baghbadorani, R.</author></authors></contributors><auth-address>School of Sports Studies and Nutrition, Faculty of Education, Health and Community, Liverpool John Moores University, Merseyside, United Kingdom.
Faculty of Food Technology and Nutrition, University of Tetovo, Tetovo, Macedonia.
School of Pharmacy and Biomolecular Sciences, Faculty of Science, Liverpool John Moores University, Merseyside, United Kingdom.</auth-address><titles><title>Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis</title><secondary-title>Nutr Rev</secondary-title></titles><periodical><full-title>Nutr Rev</full-title></periodical><edition>2018/12/14</edition><dates><year>2018</year><pub-dates><date>Dec 13</date></pub-dates></dates><isbn>1753-4887 (Electronic)
0029-6643 (Linking)</isbn><accession-num>30544168</accession-num><urls><related-urls><url>;[6] Finally NICE UK guidelines 1.3.6 Individualise recommendations for carbohydrate and alcohol intake, and meal patterns. Reducing the risk of hypoglycaemia should be a particular aim for a person using insulin or an insulin secretagogue. [2009]Often this is achieved by increasing dietary carbs at the expense of weight gain An alternative is to reduce carbs and the drugs involved this has the advantage of weight loss and improvements in BP___________________________________________________________References ADDIN EN.REFLIST 1.Zinn, C., A. Rush, and R. Johnson, Assessing the nutrient intake of a low-carbohydrate, high-fat (LCHF) diet: a hypothetical case study design. BMJ Open, 2018. 8(2): p. e018846.2.David Unwin, D.H., Geoffrey Livesey,, It is the glycaemic response to, not the carbohydrate content of food that maters in diabetes and obesity: The glycaemic index revisited. Journal of InsulinResistance,2016;1(1),a8.().3.Murdoch, C., et al., Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide. Br J Gen Pract, 2019. 69(684): p. 360-361.4.Murray, S.W., et al., The “discordant doppelganger dilemma”: SGLT2i mimics therapeutic carbohydrate restriction - food choice first over pharma? Journal of Human Hypertension, 2021.5.Unwin, D.J., et al., Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care. International Journal of Environmental Research and Public Health, 2019. 16(15): p. 2680.6.Gjuladin-Hellon, T., et al., Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis. Nutr Rev, 2018. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
Related searches
- bcps org jobs
- smartcu org sign on page
- aarp org membership card registration
- free org email accounts
- hackensackumc org pay bill
- get my transcripts org from college
- bcps org community volunteer info
- my access tgh org portal
- bcps org employee self service
- intranet florida hospital org employee
- typical finance org chart
- org chart for finance department