Diabetes

Is OPTIFAST VLCD suitable for people with diabetes?

Most overweight and obese patients with Type 1 or Type 2 diabetes are eligible to use OPTIFAST VLCD as part of an overall management program that emphasises the importance of ongoing weight maintenance.

Special care is needed when managing patients with diabetes, as a VLCD significantly reduces plasma glucose concentration independently of weight loss. For this reason hypoglycaemia is likely to occur if insulin or sulphonylureas are not reduced or stopped.

Please note that any adjustments to medication should only involve the Endocrinologist or doctor.

Considerations for Type 1 diabetes

1. Most overweight and obese patients with Type 1 diabetes can consider using OPTIFAST VLCD.
2. Due to the risk of hypoglycaemia, it is imperative that blood glucose levels are monitored more frequently for the first few days (at least 4 times per day – once before each meal and before going to bed).
3. The aim is to prevent hypoglycaemia from occurring therefore it is imperative that you work with your patient to get the insulin dosage right.
4. It is extremely important that insulin treatment is continued, no matter how low the insulin dose is. Do not completely cease insulin treatment.

Considerations for Type 2 diabetes

1. Most obese patients with Type 2 diabetes can consider using OPTIFAST VLCD as part of an overall weight management program.
2. If your patient is not on any insulin or taking Metformin, thiazolidenediones or acarbose, then they should benefit, like non-diabetic patients from the hunger-supressing effects of mild ketosis.
3. Hypoglycaemia is a risk for patients on insulin or sulphonylureas therefore it is imperative that blood glucose levels are monitored more frequently for the first few days (at least 4 times per day – once before each meal and before going to bed).
4. The aim is to prevent hypoglycaemic episodes from occurring therefore it is imperative that you work with your patient to get their medication dosage right.
5. If you are on insulin do not completely cease insulin treatment without medical supervision.

Medications

Sulphonylureas

• Reduce by 50% at the beginning of the VLED if fasting blood glucose >10mmol-1 or HB1Ac is >9-10%.
• Stop altogether if fasting blood glucose is <10mmol-1  or patient has good blood glucose control.

Long and short acting insulin

• OPTIFAST VLCD has approximately 13-22.5 grams of carbohydrate per serve, hence it is recommended that the short acting insulin be reduced to half.
• A VLCD can rapidly result in a reduction in endogenous glucose production, so the dose of long acting insulin also needs to be reduced, initially by around 50%.

For optimum management, it is recommended that patients start the regimen on the weekend, when they can be at home and thus more attentive to the symptoms of hypoglycaemia.

It is extremely important that patients diagnosed with type 1 diabetes continue insulin treatment, no matter how low the insulin dose is, to maintain euglycaemia.

For further information on the management of patients with Type 1 & Type 2 diabetes please refer to the OPTIFAST VLCD Co-morbidity Guidelines.

GI values of the OPTIFAST VLCD range