Nutrition therapy in diabetes and obesity
The physiology behind diet in diabetes and obesity, with worked numbers. Why weight loss slows (the energy gap and adaptive thermogenesis), carbohydrate counting with insulin-to-carbohydrate ratio and correction factor, glycaemic index and load, very low energy diets and remission (DiRECT), low-carbohydrate eating with SGLT2 inhibitors, alcohol and hypoglycaemia, and deficiencies after bariatric surgery.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Weight follows energy balance, but expenditure falls as weight is lost, so a fixed deficit gives diminishing returns. Predict loss with the dynamic rule, not "7,700 kcal per kg forever".
- In insulin-treated diabetes, matching insulin to carbohydrate is the core skill. The 500 rule and 100 rule estimate the insulin-to-carbohydrate ratio and correction factor.
- Glycaemic load (quantity times quality) predicts post-meal glucose better than glycaemic index alone. Fibre, fat and protein slow gastric emptying and blunt the peak.
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Sources
- Quantification of the effect of energy imbalance on bodyweight. Hall KD et al. Lancet 2011;378:826-37The Lancet, 2011
- Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lean MEJ et al. Lancet 2018;391:541-51The Lancet, 2018
- Australian Obesity Management AlgorithmAU/NZAustralian Diabetes Society and ANZOS, current, accessed November 2026
- Position statement: low carbohydrate eating for people with diabetesAU/NZDiabetes Australia, 2018
- Standards of Care in Diabetes 2026 (section 5, facilitating positive health behaviors)American Diabetes Association, 2026
- Effect of dietary adherence on the body weight plateau: a mathematical model incorporating intermittent compliance with energy intake prescription. Thomas DM et al. Am J Clin Nutr 2014;100:787-95American Journal of Clinical Nutrition, 2014
- Physiology of the weight-loss plateau in response to diet restriction, GLP-1 receptor agonism, and bariatric surgery. Hall KD. Obesity 2024;32:1163-8Obesity, 2024
- Last updated
- 14 November 2026
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