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Percakapan Dokter Pasien-4.PDF (Bahan DM)
Percakapan Dokter Pasien-4.PDF (Bahan DM)
To maintain or improve health through the use of appropriate and healthy food choices.
To achieve and maintain optimal metabolic and physiological outcomes, including:
Reduction of risk for microvascular disease by achieving near normal glycaemia without
undue risk of hypoglycaemia.
Reduction of risk of macrovascular disease, including management of bodyweight,
dyslipidaemia and hypertension.
The National Institute for Health and Clinical Excellence (NICE) recommends that the nutritional advice given to
insulin-dependent patients may need to be modified to take into account patients who are underweight, have
eating disorders, have hypertension or have chronic kidney disease. The information made available to people
with type 1 diabetes should consider cultural and religious diets, feasts and fasts and should include matching
carbohydrate, insulin and physical activity.
Exercise [4]
Regular physical activity improves insulin resistance and lipid profile (reduction in triglyceride and
increase in high-density lipoprotein (HDL)) and lowers blood pressure (although blood pressure will
rise during exercise).
The metabolic benefits in type 2 diabetes are lost within 3-10 days of stopping regular exercise.
Physical activity also protects against the development of type 2 diabetes.
It is essential to find activities that are enjoyable, achievable and sustainable, eg walks, dancing,
swimming, bowling, cycling, golf, playing with the children, DIY.
Type 2 diabetes
NICE only gives generalised advice concerning the role of physical exercise in type 2 diabetes. Guidance can be
found in the St Vincent Declaration and from the American College of Sports Medicine. [12] [13] Advise that
physical exercise:
Can benefit insulin sensitivity, blood pressure, and blood lipid control.
Should be taken at least every 2-3 days for optimum effect.
May increase the risk of acute and delayed hypoglycaemia.
Warn about:
Type 1 diabetes
Advise that physical activity can reduce enhanced arterial risk in the medium and longer term. Give information
on: [10]
1. Orozco LJ, Buchleitner AM, Gimenez-Perez G, et al; Exercise or exercise and diet for preventing type 2 diabetes mellitus.
Cochrane Database Syst Rev. 2008 Jul 16;(3):CD003054.
2. Nield L, Summerbell CD, Hooper L, et al; Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane
Database Syst Rev. 2008 Jul 16;(3):CD005102.
3. Nield L, Moore HJ, Hooper L, et al; Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database
Syst Rev. 2007 Jul 18;(3):CD004097.
4. The implementation of nutritional advice for people with diabetes, Diabetes UK
5. Diabetes UK
6. Type 2 diabetes - newer agents (partial update); NICE Clinical Guideline (May 2009)
7. Thomas D, Elliott EJ; Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst
Rev. 2009 Jan 21;(1):CD006296.
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8. Suckling RJ, He FJ, Macgregor GA; Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane
Database Syst Rev. 2010 Dec 8;(12):CD006763.
9. DESMOND project
10. Diagnosis and management of type 1 diabetes in children, young people and adults; NICE Clinical Guideline (July 2004)
11. Dose Adjustment For Normal Eating (DAFNE)
12. International Diabetes Guidelines; Newcastle University 2008.; St Vincent Declaration
13. Exercise Management for Persons with Chronic Diseases and Disabilities; American College of Sports Medicine, 2003
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