VOLUME 7 NUMBER 2 • JUNE 2010
81
SA JOURNAL OF DIABETES & VASCULAR DISEASE
really need a psychologist to help patients deal with the
emotional processes they need to go through. But what
we’re doing works well when patients follow through.
Those who are compliant gain control fairly quickly and
remain controlled. Seeing a patient achieve this is what
makes it all worthwhile for me and keeps me doing eve-
rything I can to help. I never want to ever find myself in a
situation where I feel I didn’t do enough.’
When it comes to the specifics of dietary manage-
ment, Marlene explains that she starts by evaluating a
patient’s nutritional status and taking a dietary history.
‘From these you can ascertain whether the modifications
required are dramatic or minor’, she says. ‘When weight
loss is required, as is usually the case, it’s important to
implement a stepwise approach that results in a gradual
loss. We also need to accommodate the modifications
to the structure of the patient’s life. For example, a con-
struction worker has set breaks from work during the day
and his eating plan needs to take that into account when
timing his meals.’
Diets are tailored to individual patients and need to
be energy-appropriate for their daily activities, while also
Specially chosen foods are important in diabetic diets.
balancing nutritional concerns against economic ones.
‘It’s no use prescribing foods that an underprivileged
patient is unable to afford’, says Marlene. ‘In general,
I advise diets that are high in carbohydrates, as these
promote satiety. The intake of fat is restricted, but not
completely, as fats are important to ensuring food’s pal-
atability. They’re also needed to provide essential fatty
acids. The rest of the diet is made up of protein, and of
course there are lots of fruit and vegetables, which are
beneficial in the control of blood sugar and they provide
antioxidants. We do also take glycaemic index into ac-
count, and teach patients to combine foods in such a
way as to ensure meals with lower glycaemic loads.’
Marlene underscores that there is not one ‘perfect diet’
for everyone. ‘What’s important is to give patients some-
thing workable and attainable. Something too extreme
is likely to be rejected out of hand, with patients making
no changes at all. Something more realistic might only
get them 50% of the way there, but 50% is better than
nothing’, she concludes.
Marlene talking to a patient at her work station in the clinic.
