Ashley Grachnik, Registered Dietitian, Toronto, ON

John is 55-years-old and was recently diagnosed with Type 2 Diabetes. For several years, his doctor has warned him that he was at high risk of developing Type 2 Diabetes due to a strong family history of Type 2 Diabetes, his age and obesity. John is 5 feet 9 inches tall and 220 lbs giving him a body mass index (BMI) of 32.7. John's doctor had encouraged him to lose at least 5% of his body weight (11 lbs) to reduce his risk of developing Type 2 Diabetes. Although John made some attempts to lose weight, he wasn't very motivated and never lost more than 5 lbs before regaining the weight back.

Today, John is in to see the registered dietitian to learn more about healthy eating to manage his blood glucose and to lose weight. His doctor has given him 3 months to try and manage his blood glucose before starting medications. He has been testing his blood glucose at home occasionally and is frustrated that his numbers are above target because he tells the dietitian he doesn't eat sweets.

After a review of John's diet, the dietitian identifies a few areas that John can focus on to improve his blood glucose. Although John eats an overall balanced diet and limits his intake of sweets and treats, he does have large portions and often drinks fruit juices.

John does not do any regular physical activity at this point in time. He expresses more motivation not than ever before to lose weight as he is afraid of developing the complications of diabetes and wants to know what he should do to improve his blood glucose.

Along with working with the dietitian to modify his diet to help manage his diabetes, John could benefit from consulting with an exercise specialist to add some physical activity to his routine. It is important for John to continue working with his family doctor and endocrinologist to manage his diabetes, and control his health parameters like blood glucose and blood pressure. A pedorthist could help John get fitted with proper shoes as he starts moving more. John could also try speaking with a wellness coach with help him with goal setting and using his newfound motivation to increase his success with his lifestyle efforts.

Stacey is 35-years-old and was sent to see a Registered Dietitian (RD) for some pre-conception counselling to prevent gestational diabetes (GDM). Stacey has an 18-month-old son who weighed 9 lbs and 2 oz at birth. Stacey denies having been diagnosed with gestational diabetes in her first pregnancy. Her doctor suggested she see the registered dietitian because she has multiple risk factors for developing gestational diabetes and has the opportunity to make lifestyle changes which can help prevent GDM.

At Stacey's first visit with the RD she learns about her multiple risk factors for developing GDM including her age (35 years and older), having a baby born weighing 9 lbs or greater, pre-pregnancy obesity (her current BMI is 30.2 because she had a difficult time losing the weight she gained from her first pregnancy) and a strong family history of Type 2 Diabetes as both her mother and father are living with Type 2 Diabetes. There are other risk factors for developing gestational diabetes that don't apply to Stacey including being part of a high risk ethnic group (such as Asian, South Asian, African, Aboriginal and Hispanic descent), having Polycystic Ovary Syndrome, or being treated with steroid medications.

Stacey and the RD discuss lifestyle changes that she can implement now and through her future pregnancy. This may not prevent gestational diabetes as most of her risk factors are not modifiable but Stacey agrees that healthy lifestyle changes are important to implement. Stacey could also benefit from incorporating some regular activity into her lifestyle, and could consult with an exercise specialist to develop an appropriate program to help her before her next pregnancy, and could start prenatal yoga classes. Since losing weight would help lower her risk of developing gestational diabetes, Stacey's lifestyle efforts should be targeted toward assisting her with reducing her body weight before she conceives again.

Greg is 65 years old and was recently diagnosed with hypertension (high blood pressure). He is shocked by this diagnosis. Greg has always been at a healthy body weight and feels he eats an overall healthy diet. He does not smoke and has no other health conditions. His mother died at the age of 50 from a heart attack, but otherwise he has no family history of high blood pressure or any other heart conditions.

Today Greg is in to see the registered dietitian to learn more about healthy eating to manage his blood pressure. His doctor wanted to start him on antihypertensive medication but Greg was resistant and wanted time to see if he could manage his blood pressure through lifestyle changes. Greg tells the dietitian that he eats healthy and exercises weekly. After some further probing about his diet, Greg admits he is a “meat and potatoes” guy and doesn’t love eating vegetables but that his food is always homemade. He is a truck driver but packs his own lunch to avoid buying fast food while on the road. His weekly exercise consists of 45 minutes of swimming on Saturday mornings.

Greg is ready to make lifestyle changes to improve his blood pressure. The dietitian educates Greg on the DASH diet – Dietary Approaches to Stop Hypertension. The DASH diet encourages whole grains, lots of vegetables and fruit, nuts/seeds and legumes, lean meats and fish. Increasing his level of physical activity will also help lower his blood pressure, and Greg could consult with a personal trainer for help on building up his activity level.