Diabetes guidance 1766.pdf - East Cheshire NHS Trust

LifestyleHealthy Lifestyle• Stop smoking• Healthy diet:- Eat regular meals including moderate portions of high fibre complex carbohydrate- Eat a balanced diet following the plate model* Weight loss: Half the plate should be vegetables, a quarter carbohydrates and a quarter protein.* Weight maintenance: Equal servings of carbohydrate, protein and vegetables.• Aim for at least 5 portions of a combination of fruit, vegetables or salad daily.• Oily fish twice per week.• Reduce total and saturated fat intake. Where fat is used, recommend mono-unsaturated fats such as oliveor rapeseed oil. Avoid food containing high levels of total fat (≥ 20g per 100g) or saturated fat (≥ 5g per 100g).• Reduce intake of sugary foods and avoid sweetened drinks.• Reduce salt intake to 28 kg/m 2 .• Only initiate orlistat if patient has made dietary and lifestyle changes showing motivation to lose weightfor 4-6 weeks previously. Consider referral to dietitian.• Patients should be followed up at least monthly for the first 3 months. Set targets for weight loss andconsider cessation of orlistat if these are not met. Note that the NICE advice that the weight loss target of5% of bodyweight in the first 3 months may need to be less stringent for patients with type 2 diabetes.• Patients should be encouraged to use the manufacturer’s website www.mapassist.co.uk• Weight loss and medication should be reviewed regularly and medication stopped if weight loss is notmaintained or weight is regained.• Orlistat should only be continued beyond 12 months if the risks and benefits have been discussed withthe patient. See BNF.