Diabetes UK asks if diabetics are being given diet advice that makes problems WORSE

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The classic symptoms of untreated diabetes are weight loss, polyuria increased urination , polydipsia increased thirst , and polyphagia increased hunger. No more nights up stinging, burning and RLS restless leg syndrome. On the other hand, being in ketosis does make low blood sugars less negative as an experience. I broke my foot at work on the last workday in December. High Fiber Foods for a Diabetic. Tammi, You say keto is a highly controversial topic. I read through the article, and then through all of the comments…and there is one thing that seemed to be your battle cry:

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Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?

From to he practiced Cardiology in Tucson. He was the cofounder of the Tucson Heart Hospital. For the last 20 years, Dr. Gann has been interested in a dietary approach to treating heart disease, hypertension and diabetes. He performed a study with his own heart disease patients following an Atkins type diet and was successful in reducing most coronary risk factors. It was published in the American Journal of Cardiology.

She created a multi-million dollar company, JanCo Janitorial, which started with one part-time employee herself. Elizabeth became interested in nutrition when nearly all the adults in her extended family became diabetics. Her mother died from the complications of diabetes. For this reason, Elizabeth decided to study nutrition and became a Certified Nutrition Consultant. One aspect that is not often mentioned is carb cravings. The high-fat keto diet has pretty much eliminated those carb cravings.

It is wonderful to not be under the control of those cravings anymore. I think the high success rate of keto diets is that you are not hungry and have no cravings. We have all heard of essential fatty acids EFAs and essential amino acids EAAs , but have you ever heard of essential carbohydrates?

The human body is capable of burning fat for fuel. If the body can burn fat for fuel, why would you ingest a substance carbohydrate that raises your blood sugar, raises your insulin levels, and makes you sick?

Why would the ADA advocate the very diet that made us sick in the first place? One of my favorites is Keto Mocha Mousse https: One of the keto researches commented, I think it was Steve Phinney that change will come about only because enough of the the public will be become educated about this and will demand that the ADA change their recommendations because those recommendations are just wrong.

What is the proof they are wrong? If you eat g of carb daily, you will continue to have diabetes, and the epidemic will continue as it has for the last 25 years. I know you have to earn a living, Tammi, and there is nothing wrong with that.

However, would you consider that what you are advocating, which was taught to you by mainstream medicine, might actually be harmful? And if it is, what will you do about it? That is the real controversy.

I can tell how passionate you are about this subject. This is the major difference between Ketogenic diets and a consistent, low carbohydrate diet CDEs advocate for. Eating this in the form of a Mediterranean diet is what I recommend and what my article outlined. In a perfect world, we try to have people steer clear of anything artificial or processed when possible. Just eat fresh foods, like our grandparents did, who never had these types of health problems. There are many physiological reasons for eating enough carbohydrates throughout the waking hours to maintain a steady blood glucose level…a couple of important reasons are to minimize the hepatic release of glucose from the liver and to help prevent hypoglycemia which can be very dangerous and lead to hypoglycemic unawareness over a short period of time.

Each person is different of course.. The reality is, most people with diabetes do; it can be very dangerous for some to not get enough carbohydrates at each meal. We are all supposed to be eating 5 servings of fresh fruit and vegetables per day. That provides you with all the essential vitamins and nutrients needed to run a healthy body along with the protein you choose to consume alone with them. I guess if you can fit those into a Ketogenic diet and make that work for you for a lifetime, I would have to say that is absolutely wonderful!

I just know, I have a lot of willpower and I only made it 1 year back when I tried. It was just too restrictive. I see too many stories like that. The blogger I wrote about, all the studies, most participants had dropped out at 6 months.

No study I have seen has shown anyone who has stayed on it for 10 years, 15, 20, 30, 40 years. If you know one, please let me know! Elizabeth lays it all out quite nicely — my favorite part is having almost no cravings whatsoever — talk about freedom! On the other hand, being in ketosis does make low blood sugars less negative as an experience. This is not unawareness but it is less reactive. The crazy thing is it is not hard, if it matters. Sure I can see it being hard for someone who does it to lose weight, then when they get closer to their ideal, they want to have treats, etc.

Thanks so much for starting this conversation and continuing to explore and learn along with the rest of us. The comments defending the keto diet suggest that the individuals are successfully using the keto diet to help them maintain a healthy weight and a healthier A1C level. The individuals also suggest that they view it as a way of life rather than a diet.

This is good news for many of us who are facing the question of whether it will be helpful and necessary to reduce carbohydrate intake to keto producing levels in order to halt or reverse the onset of type II diabetes.

I think like those individuals, Tami is speaking from her own personal experience where she had success losing weight, but had difficulty maintaining the keto diet long-term. I am sure that though you have been successful, you can understand that there are many who might find it difficult to maintain.

I too have been given very bad guidance by Medical Doctors who lean on old Med School information to practice medicine rather than continuing to broaden their knowledge base and learn more about nutrition. Those years are gone and the destruction to my body is not reversible. But I think that expressing anger toward those who disagree with our personal experience, is not solving the problem. Hopefully we can change the ADA guidelines by respectfully urging them to reconsider their position based on the sheer volume of the comments they receive from successful people like you, who are living the keto diet lifestyle and living better.

I commend you for becoming your own best health advocates. Thanks for your encouragement and your passion. And thanks to Tami as well for sharing her personal experience and the information she had collected. We all have to be true to what we believe and we all have a right to come to our own conclusions.

It is good to know that there are success stories out there. I wish you all good health and continued success. The system is failing so many of us. I will only believe diabetic advice from diabetics. Thank you for your wonderful comments Marcia. To share more about me personally with you all…I am not a completely non-diabetic Certified Diabetes Educator. I tested my own A1c and found it was 5. There have been years when my A1c dropped to a normal level of 5.

My last A1c in May was 5. I feel it everyday, I wonder what my A1c is going to be just like you every 6 months when I go to have it drawn. My A1c did jump to 6. The constant pain and inflammation for 6 months caused the increase. Once I had the manipulation done, completed physical therapy and the pain was gone, my A1c dropped back to 5. Most already wear an insulin pump and continuous glucose sensors CGMs also.

When I first became certified on each new pump and CGM, I would wear them and check my BG times per day for weeks, not only to learn the technology really well, but to gain a sense of how my patients must feel having to wear them 24 hours per day. These are the units where most of the people with diabetes are, so I had seen every horrific complication that diabetes can cause.

We really do only want to try and share the knowledge we have through seeing thousands of different patients with complex issues over decades with all of you. Physicians jump at the chance to have a CDE see their patients in their practice or in the hospital because they know our value. They know how thorough we are when assessing their patients and often find issues that may have been overlooked for years.

We live and breathe it and are very passionate about helping people overcome their hurdles. I do hope sharing some of my personal experience with all of you will help, but I am here if you all have more questions anytime! I have type 1 diabetes, diagnosed in when I was 24 years old.

I have to say that following a keto diet has made managing my diabetes A LOT easier. Trying to manage by covering 45g of carbs per meal, then watching my BG spike, then plummeting soon after, was a daily norm for me. If you have diabetes, you know how fatiguing of a disease it can be.

That alone tells me that keto is working for me. I hope my story has helped someone in some way. Keep up the good work. And, I have to say again, choosing the keto way of life as a type one diabetic is a lot easier than one would think, right?!.

It is so rewarding, as you point out, and actually quite easy lose the carb cravings and enjoy eating everything that you can! Also the decrease in inflammation is awesome. Fruit is tasty and enjoyable, but it is not a necessity.

Also, there are plenty of vitamins and minerals in vegetables and nuts and seeds and eggs, etc. Fruit is mostly sugar, not mostly nutrition. I love keto and I wish someone could have made me see the light many years earlier than I did.

I was diagnosed in with Brittle Type 1 diabetes, peripheral and autonomic neuropathy, and Hypothyroidism. A short time later with Gastroparesis due to the nerve damage from diabetes. Since then, I had followed every guideline and rule that the Endocrinologist and Primary Care Doctors had told me to follow.

In fact, I was gradually getting worse. So many ups and downs. Extreme highs bgl to seizures from crashes drop from to 13 in no time.

It was a constant battle with adjustments in insulin intake and different insulins NPH, R, Novolog, Humalog, Lantus , carb intake, exercise and one contributing factor was the Gastroparesis.

Meds were taken for the Gastroparesis but I always had side effects from meds. I was kicking a dead horse and I told them this. My sister and mom had come across the ketogenic way of eating and it dramatically improved thier lives. Mom was diagnosed way back with Type 2 and within a week or two she was off of her meds completely. I was totally interested. So, I decided to go for it on April 17, I did go through some rough patches of what they call Keto Flu.

It did pass after a couple weeks. I was gaining so much energy like never before as well as mental focus. I was on a sliding scale of Humalog or Novolog. From units per meal and then there were the corrections throughout my day some daily totals could be up to 40 UNITS! No more nights up stinging, burning and RLS restless leg syndrome. So, in my life, there are no questions or hardships on whether I can get off of this way of eating. If someone truly wants to have a better life, they can.

I am in the uk and a diagnosed t2d. I am also a nurse, although I am in end of life care. Up until my diagnosis I am ashamed to say the I believed in exactly th. Our health service actively promotes a carb rich diet for t2d. It was not until I did some actual research and looked at the science that I came to see that what I had been taught and what I really did believe to be the best advice was quite simply wrong.

I am not going to go on about the benefits of keto, because everyone else has admirably covered that, but I would like to address some comments made in the article. One simple thing is that at the beginning it says that most of the vegetable s are root veg. Also, as I believe is mentioned, this diet has been around for along time and was the only way to treat diabetes. And some people did die. However, people still end up dead from t2d even after all the diet advice from educators and with all that pharmacy has to offer.

An industry which gains nothing if people just choose to eat less. But has lots to gain if we just keep taking the tablets.

It is a very useful tool for epilepsy. It is extremely successful in reducing the number of seizures per day, mainly in children but also in adults. I am sure that followers of the epilepsy diet, which has been used since the s have not all starved to death. Iwould also think that the followers of this diet are also motivated to stay on it, not eat a slice of birthday cake and keep all thier brain cells.

I think what bothered me most about the article was the way in which the writer has put her own fears about living without cake onto the shoulders of any diabetic she might treat.

I must admit that when I was researching this diet I did worry that I would not have the stamina, but the thought of going blind is a useful motivator. Iwould hope to meet a diabetic nurse in the uk who was open minded about keto, but that has not been my experience as a patient. As a nurse speaking to colleagues as an equal and frmy experience has been very different. All have said they would do keto. It is very difficult to admit that something you have believed to be true is wrong.

Even harder when you have made your living by telling people that you knowhow to keep them healthy when in fact your advice has done the exact opposite. But that is no reason not to research, look at and try and understand the science. And maybe change your mind. They have amazing gut health and no t2d.

Would you like to guess at the type of diet they follow? This would be the caveman diet that the writer mentions, and yes these people might not live as long as us but the cause of death is never a lack of motivation to stay on a keto diet. This is what some doctors ask for…essentially asking for the Ketogenic diet and most of my patients are in shock!

One slice of cake is certainly not going to harm anyone with diabetes and hopefully you know enough about carbohydrates and their short term effect on BG levels to know this too!

Are you a Neuro RN? TheDiabetesCouncil did just post another article where 25 Registered Dieticians weighed in regarding the Ketogenic Diet, so I would encourage you all to check that out! It takes a very special, highly motivated patient to maintain this type of diet for the rest of their life. If you are one of those people, good for you! I wish you well!

I guess I must be a very special, highly motivated patient then. I, of course, would never have said that about myself. My high motivation is trying to get over the hatred of food that being Diabetic gave me.

Even to the extent of telling me to not include the tsp of agave that I was having in my coffee once a day because sugar is sugar. I was diagnosed as T2 diabetic in Jan with an A1C of I come from a family dominated with T2 diabetics. And fasting usually in the low 80s. Diabetic complications run rampant in my family. Kidney disease and dialysis, retinopathy, neuropathy, etc, Two days ago my brother had all of the toes on his left foot amputated. Is the diet hard to follow.

Of course it is! As for what an ethical dietician would recommend. The one I was sent to had me on 45g net carbs per meal and 15g per snack 3 times a day. I was supposed to eat at least every 4 hours. I still have the sheet he gave me. He also told me that I was in horrible shape, that I would need a lot of medication, and that because I was T2, insulin would do nothing for me. I still remember walking out of the building after.

I felt like shooting myself. My brother had just gone blind from retinopathy 2 months earlier. There was no hope for me. High numbers were inevitable. I followed the guidelines I was given with little improvement and a lot of depression. I now do 30g total not net carbs a day and no medication with an A1C under 5.

Most dieticians I have met are over rated and under educated. This article somewhat proves me out. Congratulations on your accomplishments. I have been in Ketosis for a couple of months now.

I have lost 28 pounds. No sugar No Bread Nothing from a box lol. Only good fats and Meats and good veggies dark greens mostly and a few macadamia nuts now and again and a few berries now and then. I think even the dieticians being human are also addicted to sugar and unable to give it up so they play down ketosis unconsciously because they are just jealous!

I am sorry you had this experience. I feel that this educator was not giving you good advice. All my women who want to lose weight are recommended to consume 30 grams of good carbohydrates at each meal, and 15 at each snack. If you were not trying to lose weight, I would have recommended I find this is all it usually takes to begin to lose some weight as you start to get active.

Patients set their own goals with motivational help from their Certified Diabetes Educator. Our intent is never to insult, and you should not have gone through that.

It sounds that you have now found the right path. There are many CDEs who could help you, so see what tools and motivation others may offer. Many CDEs are also diabetic. Keto Diet is NOT strictly 20 grams of carbs per day. Not only are you biased but you are not being truthful. Many people can consume 40, 50 even 60 and 70 grams of carbs per day and stay in ketosis.

It depends on the person. Age, size lifestyle and exercise all factor into how many carbs can be allowed and maintain ketosis. It is ok to not recommend a diet but when you leave out important aspects you do both your readers and yourself an injustice. You even have root vegetable and a picture of a carrot. Carrots are not part of a keto diet and as far as I have seen never were. They have 2 much sugar content and are discouraged except in very small amounts.

Are you sure you tried it? Great article in many ways but outdated in others. I think that is missing the point entirely. So many people are getting their triglycerides down, losing weight reducing stroke possibilities lengthening their very lives.

It is just not fair to not at least point out a few of these things as much as the risks you made sure to point out. How about the risks of not doing something? How about the list of people that found this and turned their lives around. Also, I know several people who have been doing keto for years.

Hello John, I will speak with the editor about switching out the picture of the carrot. I will tell you the story of a friend of mine, whom I worked with. He has a website. You may view it here: I think that he is some proof that yes, it does work. And it may be that some people do need keto. I have had reversal with regular ADA diet in my clinic. Not just a few! However, I just want for keto dieters to find a clinical trial. We do need more information. We must understand what happens in the long term on keto diet.

I personally did Atkins years ago, which was 20 grams. I had a very hard time to stay on it. I lost 20 pounds, and then I did gain it back. I just could not live without some more carbohydrates than this allowed. It seemed I was out of it at 22 carbs. Anyway, this was not for me. Maybe it is for you. No one is saying that one should never go on a keto diet, but we are wary of it. We need more science behind it. Therefore, I am just going to put this out here now.

I will paste it down the page so that others may see it. They are taking participants. Then we can be more positive about it, and recommend it if the science is there. Here is the link to the clinical trial.

Thanks for your comments:. What about those of us who are not, or never have been, obese?? There in lies the first problem. How long can it be maintained? The real question is, how long is one committed to changing their life, and how strong is their desire to do it.

They require a life-style change. Unfortunately, many first-world daily diets namely American incorporate many foods that are addictive which can cause cravings. And yes, the cravings are scientifically prove-able, and have been proved. Conditioned living if you will. There are many cultures on this planet that DO NOT grow up eating as many carbs and sweets as the American Diet, and do perfectly fine without all the sugars and carb cravings.

And incidentally, they also lead healthier lives too… Go figure. Fats are the main source of calories with it—NOT protein. Fats and proteins ARE essential for the body. The 20g of carbs are for net carbs, NOT total carbs. With fats being my main source of calories, my body and energy levels have never been better. When I educated myself on it and understood the science behind it, it was clear to see why my joints started feeling better, and ailments started to go away. I believe that nature teaches us in wonderful ways about what works.

Take the four seasons for example. I workout a lot, and a focus of mine is increasing muscle mass and strength. I go about 3 weeks of being in keto, and then for a couple of days, I eat whatever I want. That means, I can eat cake, cookies, pies, whatever I want, for those two days. I even get to enjoy birthday cake ;. Then after that, I go back to keto. We just have to understand how to listen to them. Hence the many ailments and medical conditions that keep increasing.

The point is, there are many variations of following a ketogenic way of eating, and it DOES require a life-style change. Just like any other recommendation from a dietician or educator. Here is the link for the clinical trial: I am a T2D, finally fully keto starting at the end of March. I am down 28 lbs. My goal is 50, so I am feeling encouraged and fitting into smaller sizes already.

In May my A1C was 5. I believe that is fairly accurate based on my blood sugar readings, which are staying well below I am sleeping better, my emotions are very even, I have a noticeable improvement in my energy level, and I am enjoying what I eat day to day!

The keto lifestyle sounds daunting, but it really is not. One thing many fail to mention is the hormonal shifts that occur that regulate your appetite. Give this a little time, and you will be astounded at how easy it becomes to pass on the stuff you found addictive previously.

I will refer you to the comment to John J Dozier, Jr above. Here is the link to the clinical trial:. Thank you for this info. I will be copying the link to send to some folks ready to jump on this new trend.

He was unable to speak with me so I spoke with his wife. The man had come in after having a TIA. He was a diabetic, as well.

The wife told me that she had her husband 9and herself on a keto diet. I understand when folks are worried abut their loved ones they can get pretty emotional. She tried to speak with the resident and his wife and got the same treatment. He had one in 3 days. Unfortunately with this stroke, he got anew diagnosis of severe dysphagia. SLP tried and tried but he would aspirate on everything. He had to be pegged. He was brought back to the facility. The wife was taught how to feed him through the tube.

He left the facility and passed quietly about 3 weeks later. I reached out to the wife on his second stay and we became fairly close.

She said she thought she was doing the best thing for him because he was over weight. She only wanted a healthy husband. She apologized for being so quick when we met. I thanked her for actually educating me on this diet. I was not aware there was such a thing. I recently had one of my previous cooks post that she was going to do this diet and should she start with 20 grams or 30 grams.

She has been a cook in the healthcare business for about 8 years so she understands the different diets but not the physiology behind them yet. I am trying to talk her into taking the CDM course. I told her to consult the RD at her facility before she embarks on such a trend. I feed sick people for a living.

I love being a CDM. I am grateful for the time I get to spend with the RD because I always learn something. I am saying before you start if you have ANY extenuating circumstances, please consult your doctor.

Better yet, consult a RD. This is what they do! I think some folks are being rude and hard on here and I apologize for all of them. If I could tell you how good it feels, you might understand. The choking dysphagia was not an issue until the second stroke. The TIA caused the aspiration. Yes, I believe it was the diet. If it works for you; Great! But this should never ever been tried on a man that was already sick, CBGs out of control and elderly to boot. The wife said she got it from a website such as yours.

There should be warnings posted that this is diet is not for everyone and for goodness sake talk to a professional before jumping on the trend bandwagon.

It can cause and did irreparable harm. This is why we need research before we recommend a keto diet based on opinion. Thank you for sharing this comment, Teresa. Yes, this diet needs medical professionals following you. If anyone is on a keto diet, please have them enroll in a clinical trial so that we may study its effects further.

Thanks for your comment. Sustainability is key and Keto diet is extremely restrictive compared to others. I have been on a low carb diet for over 2 years. I tried my doctors recommendations for about a year and took all the medications they told me to take. So I fired him. No one can ever tell me ketosis and ketogenic diets do not work if followed correctly. It has saved my life. I am a former earth scientist as well as a current health consultant, so it would really help me to know the answer to this question I have that keeps me up nights: The vegan diet is one of them and one which also reduces risk in most other diseases better than the others — but it is by unquestionably by far the very best diet for the environment and the survival of the planet.

A vegetable diet will END world hunger because we DO have enough earth to grow enough vegetables for everyone and we definitely do NOT have enough earth for meat eaters even at current levels. So my question to all of you is: Not to mention the horrific conditions that the great great majority of animals bred for food endure? Oh yes global warming is real and so is global cooling. About 3 years ago it was officially recognized that the earths axis has tilted a 10nth of a degree.

It has nothing to do with mankind at all! I was going to have to take a second daily dose of Metformin and the first one already played havoc with the IBS. He had cut his insulin use literally in half and lost 15 pounds. He was feeling better and visibly had more energy. I was resistant to the diet and even the idea of it.

I have been on Atkins and Sugar Busters and while I did fine on Sugar Busters back in the day, Atkins was too fat-based and that was the opposite of how I had been raised to think about dieting. I knew that the Diabetic diet given to me by the Diabetic Educator had never been enough and I get carby binge cravings even though it offers plenty of carbs and calories.

On top of that, when my stomach hurts I seek carbs, and it hurts quite often. To be fair, just the act of tracking my food improved my outcome on either. Furthermore, there is evidence that, far from helping, the advice most frequently offered about diet may actually be making it harder for type 2 diabetics to keep their condition in check. Type 2 diabetes normally occurs when fat clogs the liver, which regulates the supply of glucose to feed the body, and the pancreas, the tiny gland behind the stomach that produces the hormone insulin that takes glucose out of the blood stream and into cells.

This means blood glucose levels return to normal immediately, an effect that lasts at least two years. If I had the disorder, I would do this,' he says. But the dietary advice on how to get there may do more harm than good, say some experts. According to Nice, anyone with type 2 diabetes should be encouraged to eat 'a healthy, balanced diet that's applicable to the general population' - in other words, meals containing a balance of protein, vegetables and, crucially, plenty of starchy carbohydrates including bread, rice and pasta.

However, some experts now insist that such a diet can actually contribute to type 2 diabetes. It's not just Nice which says type 2 diabetics can continue to eat carbo- hydrates or sugary foods.

The charity Diabetes UK reassures visitors to its website diabetes. We all enjoy eating sugary foods occasionally, and there's no problem including them as a treat in a healthy balanced diet'. However, Dr Aseem Malhotra, consultant clinical associate to the Academy of Royal Colleges, last month challenged the charity to explain why it continues to recommend 'carbo- hydrates known to promote fat storage and hunger' to a group of people most of whom urgently need to lose weight.

The best long-term intervention for type 2 diabetes, says Dr Cavan, is to restrict carbohydrates by cutting back on sugar and starch and replacing it with non-starchy green veg, with some fatty foods such as cheese and full-fat, unsweetened yogurt along with calorie-dense protein. Nigel Fowler is a living testament of the benefits of this approach. Now 44, he was diagnosed with type 2 diabetes in November and his blood sugar levels were so high that he needed six injections of insulin a day.

Even this didn't stop his blood glucose from swinging chaotically, yet he says: Nigel Fowler, 44, he was diagnosed with type 2 diabetes but got no advice on diet. Rather than advising him to change his diet, the nurse put the cake into the calculation to decide how much insulin he'd need. It was like hitting my head with a hammer and then taking painkillers for the pain. In March this year, property manager Nigel, from Norden near Rochdale, read an article discussing new evidence of the health benefits of low-carb, high-fat diets and decided to reduce the amount of starchy and sugary food in his diet - cutting out bread and cakes and replacing his breakfast cereal with berries and double cream to fill him up for the morning.

What a difference,' he says. He has lost a stone since March - but says the real difference is 'the calming of the yo-yo effect on my blood glucose. I've lost the bit of fat around my middle and just feel fitter and generally happier. It's an approach that's gaining in popularity. Around , people now swap tips on the online forum diabetes.

Reading their stories led David Unwin, a Southport GP, to fundamentally change the way he approached diabetes with his patients. Last year, the journal Diabetologia published a study of 19 patients with type 2 diabetes at Dr Unwin's surgery, who lost an average of 8. Later this year, Dr Unwin is set to publish a further study of 69 patients with non-alcoholic fatty liver disease, a precursor of type 2 diabetes as well as heart disease, showing a 46 per cent improvement in liver blood tests, and therefore a reduced risk of high blood glucose levels after an average of 13 months on a low-carb high-fat diet.

The property manager decided to reduce the amount of starchy and sugary food in his diet. Another alternative is a very low calorie diet VLCD. This was tested in a ground-breaking study carried out by scientists at Newcastle University and published in in the journal, Diebetologia. All 11 patients in the study reversed type 2 diabetes after an eight-week diet of calorie-per-day liquid sachets of soups and shakes containing essential vitamins and minerals.

As yet it's not available on the NHS, pending a five-year ongoing study, funded by Diabetes UK, to test whether people can undergo such a diet under the supervision of their GP safely and effectively. A key factor is that dieters must stop their diabetic medication before they begin the VLCD, because the combination of drugs and diet could cause their blood glucose levels to plummet to dangerously low levels. Despite the clear importance of diet to type 2 diabetics, anyone who feels they need weight and lifestyle advice should ask for it - don't presume it will be offered.

While some GPs and their specialist diabetes nurses are very good at discussing this with patients, Dr Unwin says others can feel that mentioning weight problems, even obesity, is too personal, even rude. As to how to lose weight, that wasn't my field so I'd send them to a dietitian. When the condition cannot be controlled by lifestyle changes alone, the first drug someone with type 2 diabetes is normally offered is metformin. These tablets reduce the amount of glucose released by the liver and make the body's cells more sensitive to insulin.

Yet some people find the drug does not work or they cannot tolerate it, and they need additional or different medication to help keep their blood sugar stable.

There are some effective alternatives that prevent hypos when blood sugar dips too low and weight gain.

Are diabetics being given diet advice that just makes their problems WORSE?