Dietary advice for people with diabetes who are underweight or who have experienced weight loss

Patient Information Leaflet

Introduction

This dietary advice leaflet gives some general information for people who have diabetes, and who are underweight or who have experienced weight loss. If you need more detailed advice, or if you are following a special diet that makes it difficult to make these changes, please ask your GP to refer you to a registered dietitian.

How can I make the most of my food?

Using the advice in this leaflet will help you to make the most of your food. It is important that your body has enough calories (to give you energy) and protein. Foods that are mainly higher in healthy fats are more energy-dense, and are therefore good to include when your appetite is poor as they increase calories in a small volume. They also have the bonus that they have very little effect on blood glucose levels. Higher fat foods include whole milk (blue top), cheese, double cream, nuts and seeds, butter, full fat yoghurt, oily fish, avocado and extra virgin olive oil.

If you want to gain weight, prevent or minimise weight loss, try to eat little and often. Eat small meals with snacks and nourishing drinks in between such as whole milk (blue top), milky coffee or low sugar hot chocolate powder made with whole milk or fortified.

Protein-rich food should be eaten three times a day, e.g. one type with each meal, if you are trying to put weight on. Examples of protein-rich foods include meat, fish, eggs, cheese, milk, full-fay Greek yoghurt, low sugar beans, lentils, chickpeas and vegetarian alternatives to meat such as soya, tempeh and tofu.

It is important that you eat what you fancy when your appetite is poor. This means that you might want to treat yourself to small amounts of sugary food that you would usually limit. Please note that it is recommended that you avoid sugary drinks unless you are unable to tolerate solid food.

If you are concerned about high blood glucose levels, please speak to your diabetes team. They will be able to provide advice about medication to help keep blood glucose levels under control.

How can I add extra nourishment to my diet?

Here are some ideas:

Breakfast

• Full cooked breakfast, such as sausages, bacon, eggs and beans with toast or hash browns.
• Baked beans on toast.
• Protein pancakes with almond flour
• Scrambled egg on toast.
• Breakfast cereal or porridge topped with:
• Full fat yoghurt with granola
• Seeds and nuts.
• Cream or soya cream.
• Fortified milk (see section on ‘Fortified milk’).

Other meals

• Sardines in tomato sauce on toast.
• Jacket potato with baked beans and cheese.
• Egg mayonnaise sandwich.
• Ham omelette with a slice of bread and butter.
• Balanced ready meals.
• Salmon in a creamy sauce with vegetables and mashed potato, made with extra butter and whole milk.
• Chicken with a creamy sauce, fried plantain and callaloo.
• Homemade meat, vegetable, lentil curry with extra paneer or cream added, and served with egg-fried rice or chapatti spread with butter.

You can add extra nourishment to your meal by:

• Grating cheese over it.
• Drizzling olive oil over pizza bases, pasta and salad.
• Adding nuts, for example, peanuts to stir fries.
• Adding grounded nuts to your porridge or cereals.
• Adding seeds and nuts to salads.
• Adding a creamy sauce.
• Adding mayonnaise to sandwiches.
• Adding cream, soya cream, whole milk or coconut milk to soup.
• Adding the following to your mashed potato:
  • Extra butter.
  • Grated cheese.
  • Cream or soya cream.

Snack ideas

• A handful of nuts and dark chocolate.
• Slices of apple and cheese.
• Double cream with berries.
• Cheese and crackers.
• Peanut butter or hummus on crispbreads.
• A small portion of cereal e.g. one Weetabix with whole milk and double cream.
• Finger food such as sausage rolls, cocktail sausages, scotch eggs and quiche.
• Samosa, pakora or spring rolls with full fat yoghurt dip.
• Corn, pineapple or plantain fritters.
• Full fat Greek yoghurt, nuts and berries.
• Glass of whole milk and rich tea biscuits.

Fortified milk

It is easy to add extra calories and protein to milk.

Simply make up one pint of milk (ideally whole milk) with four tablespoons of skimmed milk powder. To do this, start by adding a small amount of milk to the powder to make a paste and then add the rest of the milk to make the pint.

This can be covered and stored in the fridge for use in drinks and food throughout the day. You can also add one teaspoon of milk powder to each hot drink, for example, a cup of tea or coffee.

Nourishing drinks

• Milk – try to have at least one pint a day (whole milk is the most nourishing).
• Calcium-enriched milk alternatives, for example, soya milk, coconut milk, almond milk
• Milky drinks made with whole milk such as milky coffee, Horlicks Light, Ovaltine Light, low sugar (light) hot chocolate powder.
• No-added-sugar liquid milkshake flavourings (powder or liquid) added to whole milk.

What if making the most of my food is not enough?

If you are struggling to make the most of your food using the advice in this leaflet, and/or still not reaching your goals, you may need to consider using nutritional supplements. Some of these can be obtained at pharmacies or at supermarkets without a prescription (this is known as ‘over the counter’).  Your doctor can prescribe some nutritional supplements but it is advisable to seek advice from a dietitian for personalised advice.

Nutritional supplements sold over the counter e.g. Build-up or Complan

• These are packets of powder that can be stored ready for use when required.
• Savoury soups are made using hot water.
• Sweet shakes are made using milk.
• Drink after meals, or as meal replacement if you are unable to prepare a meal or your appetite is particularly poor.

Prescription nutritional supplements

• Milky varieties are best for people with diabetes.
• Vegetarian and Vegan options are also available.
• Have them after meals or if meals are skipped.
• Can be stored in a cupboard closed.
• Taste better chilled
• Can be added to food.
• Can be refrigerated for 24 hours after opening which allows you to split them into smaller doses if you want.

Vitamins and minerals

Normally, it is recommended that people eat five different portions of fruit and vegetables a day. A portion of fruit is what fits in your hand and a portion of vegetables is two to three tablespoons. If you are struggling to eat enough due to a poor appetite, and you are not taking any nutritional supplements containing vitamins and minerals, you may wish to consider talking to your GP, pharmacist or dietitian about taking a vitamin and mineral supplement.

What if I cannot tolerate solid food?

If you cannot manage solid food, have drinks containing carbohydrate, such as:

• Drinking yoghurt
• Milkshakes
• Fruit juices
• Smoothies
• Sports drinks
• Normal (not sugar-free) squash
• Normal (not sugar-free) pop

If you are struggling to keep your blood glucose between 4 to 13.9mmol/l, please contact the health professionals who helps you to manage your diabetes for advice because you may need to adjust your medication.

If you have any questions, or if there is anything you do not understand about this leaflet, please contact:

Diabetes Dietitians at Russells Hall Hospital on 01384 244 399 (8am to 4pm, Monday to Friday)

Diabetes Dietitian at Brierley Hill Health and Social Centre on 01384 321 420 or 01384 244 399 (8.00am to 4.30pm, Monday to Friday)

Russells Hall Hospital switchboard number: 01384 456111

If you have any feedback on this patient information leaflet, please email dgft.patient.information@nhs.net

Originator: Nutrition and Dietetics Department Date reviewed: January 2024 Next review due: October 2026 Version: 3 DGH ref: DGH/PIL/00954