Sunday, 12 June 2016

Musings on pre-Diabetes and dieting

After my GP's recent disclosure that I am at high risk of developing diabetes, I have defaulted into self-education mode, which has loud echoes of what I did when I was diagnosed with CKD. In some ways it is a shame that the NHS isn't a bit more proactive with constructive support, admittedly both my GP and consultant have encouraged weight loss and a healthy diet, but I am already attempting both to some success and it's pretty generic advice short on the specifics of what will deliver actual results.

It's still a bugbear of mine that in early appointments after my CKD diagnosis the (previous) consultant and registrars I saw debated referring me to a dietician and prescribing Orlistat but never did (although they never definitively ruled them out, it was more a decision for another time that never came). I even discussed Orlistat with my GP, but again without meaningful conclusion. It was only when my first phase of weight loss flat lined at 125kg that we skipped to the nuclear option of stomach surgery, although ironically that requires a referral to a dietician first. Without abdicating my own personal responsibilities; I suspect I’ve been hoodwinked by the schtick around the NHS getting serious on supporting health issues earlier when costs are lower.

The surgical option has been withdrawn from the table for now, but I still think I could benefit from professional advice on dieting that is tailored to me rather than the hypothetical Mr Average. Pre-diabetes adds an extra complexity to what is already a minefield of conflicting advice. I avoid adding salt where possible and reserve certain foods such as crisps and peanuts as occasional treats, I try to opt for low fat and low sugar options whilst being mindful that when either fat or sugar is reduced in many products the other is substituted to maintain palatability. I believe that many of the staples of my current diet such as bread, pasta and potatoes are much reduced in diabetic diets, but removing them from now is not straightforward, I need genuinely palatable alternatives that are capable of making me feel full need to take their place. Palatability is a major weak point in many diets, and substituting staples with alternatives that leave you hungry half an hour later is setting up for failure.

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