Who are the best low-carb patients?

Who would be the best candidates?
Which patients shall we try this approach on? The irony for me is now, the best patients
were previously my worst patients. So I’m actually excited
by people who are heavy, particularly those with a large belly, because these are the ones
you may be able to do your best work with. And amongst that group, so these are
the heavy people with type 2 diabetes, there are some golden opportunities. The golden opportunities are people maybe they’ve just had
a diagnosis of pre-diabetes. So they’ve just had their blood test. You’re going to tell them
about the blood test, that, says maybe their
hemoglobin A1c is raised, these people are
a little alarmed by this, but it’s the perfect time
to rather than just worry a patient, give them a way out. The same applies in a way for those who
you’re going to say for the first time, “You’ve got type 2 diabetes.” It’s a similar thing, a golden opportunity
of somebody with a new diagnosis who is wondering,
“What’s going to happen to me?” If you have a patient with type 2 diabetes
who’s just had a really bad result and you’re going to start some new medication
or you are thinking of doing so, what about the idea
of offering them an alternative? How do they feel
about long term medication? Are they interested in trying
some lifestyle alternatives? So it’s interesting for me, for four and a half years I’ve said
to patients,”You’ve got type 2 diabetes. “I’m wondering about starting metformin. “How do you feel
about lifelong medication? Because we could try, if you’re interested,
an alternative.” How much better putting it like that
where you’re saying to patients, “How should we play this?
How should we do it?” Rather than be prescriptive.
Why not give them an alternative? And I find that this
sets the patients off, thinking about what part
they can play in their own management. So this is how a golden opportunity
becomes progress, because the patients are opting
in to a lifestyle change, when you’ve offered it
as an alternative. Just to develop that a little more, some of the best work we’ve ever done has been with people already
on maximal oral medication, who sadly have a really bad,
a really high hemoglobin A1c. And I would be thinking
about insulin for them. They are a particularly
great group to work with, because they’re so keen
to avoid injectable medication. And so when you’re saying to them,
“I’m worried about your diabetes. “We may have to use insulin, “but there are some alternatives
we could explore as an alternative, how do you feel about this?” These open-ended questions,
as long as you wait for the answers, mean they’re very interested
in exploring alternatives, particularly to insulin. And actually the evidence is
if we can avoid insulin, we’ve probably done a good thing. So those would really be
the golden opportunities for me.

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Reader Comments

  1. Marc Mayer

    Nice series. Look forward to more. Personally have been on LCHF for nearly 3 years and doing great. Professionally, I have many of my patients on the lifestyle and also having great success.

  2. Derek Robbins

    Excellent approach Dr Unwin!
    Get the patient involved in the decision making and give them the ultimate choice. Psychology at it's best!

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