Last night I saw a stoical and charming lady of 89 who had diabetes and uncontrolled high blood pressure. Her diabetes was managed but uncontrolled on a fairly standard British diet and you can probably guess what it was. Porridge for breakfast with semi skimmed milk, a whole wheat bread sandwich for lunch with paste or cheese, and a cooked meal from one of those companies that supplies the multitude of old people up and down our country because it can be easily popped in the microwave. When she is hungry in between meals she has a biscuit or a little piece of cake. The standard approach, after advising less cake and biscuits, is to tell this lady to take more and more medications to bring down her blood pressure and glucose. These drugs cause increasing side effects, and sometimes admissions to hospital. Indeed, there is a study that shows that if you take a group of elderly people and split them in half, and half of them have their medication reduced, and half have it unchanged, that after one year more people are alive in the group that have had their medication reduced.
I asked her what she would like to do.
Would you rather take more tablets for your blood pressure (she was already on 5 medications) and diabetes?
Or would you rather try something a bit different?
Even at 89 she wanted to hear about a different approach.
This is what I told her. Your body cannot control its own glucose properly and that has a knock on effect on how your body works. The easiest way to help it is to avoid eating sugary and starchy foods. These foods are moreish (addictive) and it is important to give them up. It is a choice you can make instead of adding in more medications.
If you want to do this I suggest the following:
Base breakfasts around eggs, or bacon, maybe with some tomatoes or spinach
Base lunches around meat/cheese/poultry/fish salads- e.g. a slice of beef and salad or a tin of tuna /salmon and salad
Base evening meals around meat/cheese/poultry/fish with vegetables and/or salad.
For snacks I suggest olives, or hard-boiled eggs, or slices of cooked meats, but these snacks should not be necessary as time goes on.
Talk to your family and carers about how you can do this and bring them back in a couple of weeks to discuss further.
Here is my card with a list of helpful websites.
I suggest you gradually withdraw and change over a 6-week period, because if you do it all at once you will get low carb flu and that is a bit much at your age.
I am pleased to say she is going to try that.
In a few weeks I will see if her blood pressure and HBA1c have improved. I will need to help her further with the diet- people often have many questions once they get going with it.