Low-Carbohydrate Nutrition Approaches in Patients with Obesity, Prediabetes and Type 2 Diabetes

Low Carb Nutritional Approaches - Guidelines Advisory

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3 Assessment Vital Sign Essentials • Weight • Height • Waist circumference ▶ Start at the top of the hip bone, then bring the tape measure all the way around the body, level with the umbilicus. The patient can hold the beginning of the tape measure at the umbilicus and rotate 360⁰ in front of you to accomplish this. ▶ Make the tape snug but not tight and record the measurement right after exhalation. Note: if waist circumference multiplied by 2 is greater than the patient's height, then risk is higher for metabolic syndrome. Use the same unit of measurement for both (e.g., inches). • Blood pressure and heart rate ▶ Patient should be seated, relaxed, and rested for 5 minutes prior to measurement. Use appropriate sized cuff, as a cuff that is too small falsely elevates the reading. Note: Many patients with diabetes have stiff arteries due to arteriosclerosis, which can cause a falsely elevated blood pressure reading. Basic Level Tests (consider for all) • Complete blood count (CBC) • Fasting complete metabolic panel (CMP), including: glucose, electrolytes, kidney function, bicarb for acid/base balance, liver panel • Fasting lipid panel, including: TC, HDL, LDL, triglycerides with attention to the TG/HDL ratio and TC/HDL ratio • Strongly consider screening all patients with obesity and type 2 diabetes for sleep apnea (home screening options readily available) • Strongly consider screening for food and sugar addiction • Thyroid-stimulating hormone (TSH) • Hemoglobin A1c (HbA1c) • Urine microalbumin (for patients with diabetes not taking ACE inhibitors or ARBs)

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