GLP-1 or GIP diabetes treatment

How much should I be eating?

This medication can give you an opportunity to learn to recognise feelings of fullness again. Begin to reduce your portions and relearn what the right portion size is for you now. This will help to manage your blood glucose and help you to lose weight. The handy portion guide shows you what you are aiming for. You may want to reduce your portions gradually.

Further tips for eating in smaller portions:

• Buy less food when you go shopping.
• Cook less food at home.
• Swap to a smaller plate.
• When eating out, share a main meal or choose smaller meals such as starters.
• When eating at other people’s homes, tell them in advance that you only need a small portion.

Handy portion guide

Your hands can be very useful in estimating appropriate portions. When planning a meal, use the following portion sizes as a guide:

• Starchy carbohydrates and fruit: Choose an amount the size of your fist for
  both starchy carbohydrate and fruit.
• Vegetables: Choose as much as you can hold in both hands.
• Meat and alternatives: Choose an amount up to the size of the palm of your hand and the thickness of your little finger.
• Fats: Limit fat (oil, spreads, mayonnaise) to an amount the size of the tip of your thumb.
• Dairy products: Suggested portion of cheese is the size of two fingers.

Be carbohydrate aware

A high carbohydrate diet produces excess insulin in the blood which in turn deposits calories in the fat cells. This can cause weight gain, increased hunger and (or) slow metabolism. Be aware of the amount of carbohydrates you eat.

Types of carbohydrate

Starchy

• Bread
• Potatoes or sweet potatoes
• Pasta
• Rice
• Noodles
• Oats
• Breakfast cereals
• Yam
• Plantain
• Pastry
• Crackers

Sugary

• Sweets and toffees
• Puddings
• Chocolate
• Ice cream
• Cakes
• Biscuits
• Sugary drinks
• Jam and marmalade

Naturally sweet

• Fruit
• Fruit juice
• Milk
• Dried fruit
• Tinned fruit
• Yoghurt

Carbohydrate tips

• Include a starchy carbohydrate food at each meal in the portion size suggested in the handy portion guide.
• If you want to eat a smaller portion, this is ok but aim to be consistent with these portions day to day.
• Space out your meals over the day, around 4 to 6 hours apart.
• If having a snack containing carbohydrate between meals, keep to small portions such as one portion of fruit at a time. Choose healthy snacks most of the time.

Eating fried or fatty foods can increase the side effects from GLP-1 or GIP. Reducing the amount of fat in your diet will help, as well as supporting you in losing weight and keeping you healthy. Fats have the most calories of all the food groups. All fats, even heart healthy types, are high in calories. Aim to keep to the portions sizes as recommended.

Further tips to reduce your fat intake:

• Avoid takeaway food as much as possible as these are generally very high in fat.
• Eat less high fat snacks such as biscuits, crisps, cake, chocolate desserts, pastries and nuts.
• Grill, steam, bake or microwave foods instead of frying.
• If you use oil in cooking, use a spoon to measure it out rather than
  pouring it straight into the pan. Keep to one teaspoon per person.
• Cut the visible fat off meats and remove the skin from chicken and turkey.
• Eat less cheese. Choose alternative sandwich fillings, less cheese based hot meals, use less in cooking and when including cheese, aim for the portion
  size.

Lots more information can be found on the websites suggested on this page.

When we eat, there is a delay between us having eaten enough and our brain getting the message. This can take at least 20 minutes. During these 20 minutes or more, you may think you are still hungry and continue eating. By the time your brain knows you are full, you may have eaten more than you need. This may increase side effects of nausea and discomfort, but also makes it harder to lose weight. This section introduces you to tips to help you to tune in to your body’s feeling of hunger and fullness.

Slow down your eating

To help give your brain time to catch up with your stomach, eating more slowly
has been shown to help. Try these tips:

• Use a knife and fork where possible. You are much more likely to eat too
  quickly when using your hands. Cut food into smaller pieces and put your knife and fork down between mouthfuls.
• Sit down to eat when possible. Eating on the move makes it harder to concentrate on slowing down your eating.
• Avoid multi-tasking. Focus on your eating rather than watching television, reading or using your phone.
• Focus on tasting and enjoying every mouthful of food.
• Have a break midway through your meal. Put your knife and fork down for a few minutes. If eating with others, have a conversation.
• Avoid having second helpings. At the end of a meal you should feel comfortably satisfied but it is normal to feel you could still eat some more. It is important to get used to this feeling and not to go back for seconds. You can always eat again in a few hours if you are still hungry later.

Get snacking under control

Try to only eat when you are truly hungry. Most of the snacks we have, are due to cravings or habits rather than physical hunger.

Ask yourself:

• Am I really physically hungry: Physical hunger doesn’t tend to go away when you are distracted. You may have an empty feeling or a rumbling stomach. Does the timing of your hunger make sense? If it has been four hours since you last ate, it is more likely to be true hunger than if it is just after a meal.
• Could this be a craving: Cravings may feel like physical hunger but there are some clues to help you decide. Cravings can be at any time, even straight after a meal. They are often triggered by emotions, boredom or by simply seeing, smelling or hearing about a food. Cravings tend to be for specific foods we enjoy which are often high in sugar, salt and fat.
• Could this be a habit: Habits are not hunger or cravings. Habits tend to happen repeatedly and are triggered by time or routine. For example eating supper every night even though you are not hungry; buying a chocolate bar
  each time you go to a petrol station; or having pudding after your main meal even though you are full.

Tips to beat cravings

• Once you have recognised your cravings you can start to try and resist them. Most cravings last for 5 to 10 minutes and will go away, especially if you distract yourself by keeping busy.
• Avoid temptation. Try to keep tempting food out of the house.
• Ask family members to support you in this if necessary. It is part of your treatment.
• Try having a sugar free drink instead of eating.
• If you do decide to have a craved food, try to have the smallest portion that
  will satisfy your craving. Take your time and savour the taste, try to make it
  last as long as you can.
• Recognise what triggers cravings and try to address this. For example, if it is boredom, find activities to keep you busy such as walking, crafts, reading, puzzles, having a bath or shower. If it is low mood or anxiety speak to your doctor or nurse about counselling available locally.

Tips for changing habits

• Sometimes we have had habits for a long time. Some people can change these straight away and for others this can take more time, effort and support. Ask for help if you need it.
• Try to change the routine that leads to the habit. For example, pay for your petrol at the pump, stay out of the kitchen at bedtime.
• Reduce the portion size of foods you eat out of habit. For example, if you usually have two biscuits at bedtime, have one instead.

Physical activity can help to reduce your blood glucose and support weight loss, it is also a good way to distract yourself and manage cravings. Most people can do some activity, but if you are unsure because of your health, ask your doctor for advice before you start.

The government advises a minimum of 150 minutes of moderate activity each week for general health, you can split this up into five lots of 30 minutes or ten lots of 15 minutes or whatever amount suits you.

Moderate activity should make you breathless but not speechless. You should exercise at a comfortable pace for you, building up slowly if you have been inactive.

Tips for increasing physical activity

• Build in activities after meals such as going for a walk or doing some housework. This can distract you from cravings after meals.
• Try to think about what you can do rather than what you can’t do.
• For example, if you can’t walk far, can you stand more often? If you can’t stand, can you move your arms more often?
• If you are already active, try adding in more activity if you can.
• Suitable activities could include walking, swimming, cycling,
  dancing, housework, gardening and washing the car or windows.
• Keep a record of your progress to see how far you have come, you could write this down or use a fitness tracker. This can help you to stay motivated.

Keeping a track of your progress

It can help to keep a food diary when you first start to make changes, this is especially useful for your nurse or dietitian appointments. A food diary could be on paper or on an app on your phone, whichever suits you best. You could even take photographs of your meals if you do not like writing things down.

You could add notes about your blood glucose if you check at home, identify if you were hungry or if you ate through habit or cravings and any triggers for eating. You can also add information about your physical activity levels.

It is helpful to review your diary and see where you have made changes that have helped to reduce your blood glucose levels or weight, or where you might want to make further changes.