Preventing Transition to Insulin for an Overweight Diabetic

Case Study: Preventing Transition to Insulin for an Overweight Diabetic

Patient Profile

• Age & Gender: Male, 60 years

• Ethnicity: White

• Medications: Metformin, Empagliflozin, Statin

Reason for Referral

The patient, a 60-year-old male with a long-standing history of type 2 diabetes, was referred to our dietitian to receive guidance on weight management and diabetes-specific dietary advice. With rising HbA1c levels and a high BMI (37.8), he faced an increased risk of requiring daily insulin treatment. Our goal was to help him manage his diabetes through lifestyle changes, reducing his HbA1c to a healthier range and improving his weight and BMI.

Dietary Intervention
Our dietitian began with an initial assessment of the patient's current diet, lifestyle, and understanding of nutrition. The intervention focused on several key areas:

• Carbohydrate Awareness: Educating the patient on the impact of different types and quantities of carbohydrates on blood glucose levels. We focused on identifying high-carb foods, understanding glycemic index values, and creating a balanced approach to incorporating carbs in meals.

• Portion Control: Encouraging awareness of portion sizes, especially with calorie-dense foods. We worked on visual tools for portion sizes and discussed practical ways to manage intake without feeling restricted.

• Balanced Eating and Snack Choices: We explored healthier snack options and meal ideas, focusing on nutrient-dense foods that promote satiety. Emphasis was placed on incorporating fiber-rich foods, lean proteins, and healthy fats to create satisfying, balanced meals.

• Physical Activity: Recognizing the role of movement in blood sugar control, we discussed realistic ways to incorporate physical activity into his daily routine. This included short, daily walks and light resistance exercises to support both weight loss and metabolic health.

Through regular sessions, our dietitian provided personalized meal plans, practical tips, and motivational support to empower the patient to make sustainable changes.

Outcomes

• HbA1c: The patient's HbA1c dropped from a critical level of 100 mmol/mol to 47 mmol/mol, significantly lowering his risk of progressing to insulin therapy and achieving a level closer to optimal diabetes management.

• Weight and BMI Reduction: Through gradual lifestyle changes, he reduced his weight from 108 kg to 103 kg, with a BMI reduction from 37.8 to 35.6 kg/m². This weight loss contributed positively to his glucose levels and overall health.

• Avoidance of Insulin Treatment: By improving his blood sugar control through diet and exercise, the patient avoided the need for daily insulin treatment, which would have impacted his daily routine and potentially led to further complications.

• Risk Reduction for Diabetes Complications: Improved glucose control and weight loss have contributed to a lower risk of complications associated with diabetes, such as cardiovascular disease and kidney issues.

Conclusion

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This case highlights the impact of a dietitian’s role in preventing the need for insulin therapy and in supporting patients with effective, evidence-based lifestyle changes. Through personalized education, practical support, and encouragement, the patient achieved significant health improvements that enhance his quality of life and long-term prognosis.

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