The Duval Clinic team takes your health at heart and wants to optimize your recovery after your surgery. You have insulin resistance or confirmed diabetes. We therefore suggest that you follow these nutritional tips to improve your health and reduce the risk of complications after surgery. Your collaboration is important.

To achieve the recommended goals for blood glucose control and reduce the risk of complications, it is
recommended to:

• Have a balanced diet
• Act on excess weight
• Get regular physical activity
• Quit smoking
• Manage stress
• Take your medication as prescribed

Nutrition and diabetes
Basic tips
• Eat three balanced meals a day and snacks as needed. Avoid skipping meals.
• Keep a regular meal schedule. Meals should be about 4 to 6 hours apart. Snacks should be taken 2 to 3 hours after the meal, if applicable.
• Eat a variety of foods from the different food groups: vegetables and fruits, starchy foods, milk and alternatives, and meat and alternatives.
• Choose foods rich in dietary fibre: vegetables and fruits, whole grain products, legumes, nuts, seeds, etc.
• Compose your meal according to the balanced plate model.
• Limit the consumption of sugary, low-nutrient foods (cakes, pastries, sweets, chocolate, cookies, brown sugar, honey, molasses, syrups, jams, etc.). These should only be eaten in small quantities and only occasionally.
• Choose water to hydrate yourself rather than fruit juices and sugary drinks.
• If you use sugar substitutes (aspartame, sucralose, cyclamates, saccharins, stevia, etc.) or products that contain them, do so in moderation.
• If you drink alcohol, do so preferably with food and stick to the recommended amounts.

Pay particular attention to portion sizes and the distribution of foods containing sugars/carbohydrates.

The main sources of sugar in the diet
• Starchy foods, for example: bread, pasta, rice, potatoes, corn, peas, legumes, cereals, rice noodles,
cereal flour cakes, cassava, yams, plantains, etc.
• Fruits, fruit juices
• Milk, yogurt, dairy desserts (except cheese)
• Sweetened products; for example: sweetened drinks, pastries, chocolate, jam

Diabetes = diet?
The concept of restrictive diet is avoided in favor of a balanced and varied nutrition in which no food is forbidden. A meal has less effect on glycemia (blood sugar level) when it is balanced; i.e., when it contains a protein equivalent (dairy products, cheese, fish, eggs, meat, etc.), vegetables, and starchy foods. A small amount of sugar, if taken during a balanced meal, has little influence on blood sugar levels. All vegetables are allowed. Fruits containing sugar (fructose) are allowed, if the quantities consumed are reasonable.

Snacks may sometimes be necessary, but they are not mandatory. This will depend on many factors to be assessed: blood sugar level (glycemia), type of medication, physical activity, habits, hunger signals between meals, possible delays in eating, or eating an incomplete meal. Note that energy expenditure in the elderly is higher than in adults. The risk of hypoglycemia must be recognized even during activities such as gardening or physical therapy. Snacking and drinking may be necessary.

Weight loss is desirable for overweight people because it improves blood sugar levels and reduces cardiovascular risks. However, the diet must remain balanced to avoid the risk of malnutrition. For support in changing your eating habits, ask for a personalized follow-up by a qualified dietician (the cost is reimbursed by the basic health insurance).

We advise you to consult these sites for more information:

Physical activity and diabetes

An active lifestyle is a must for the person with insulin resistance/diabetes. Physical activity increases the effectiveness of insulin by improving the sensitivity of body tissues to its action. This effect persists for several hours after the activity. In addition, the muscles involved in the exercise consume glucose (sugar), thus lowering blood levels. Physical activity helps prevent long-term complications of diabetes. In people with pre-diabetes, it can also delay the onset of diabetes.

Being active does not mean that you must play sports. Physical activity also includes, for example, parking your car further away, getting off public transport one stop earlier, dancing, walking your dog…

We can distinguish between light, medium, and intense physical activity.

Light intensity Normal breathing without sweating
Medium intensity A slight acceleration of breathing without the individual necessarily sweating
High intensity Accelerated breathing with sweating

A light activity for one person may be an intense activity for another untrained person, so it is important to respect personal limits. Regular physical activity is an integral part of treatment, as are diet and medication. It is important to respect one’s own rhythm, to listen to one’s body, and to keep the objective of “pleasure” in mind.
Ideally, physical activity should be done on a regular basis.

Benefits of physical activity
Any increase in physical activity, no matter how small, will be beneficial!
Physical activity has many benefits on:
Blood glucose
• Increased energy consumption of the muscles
• Improved insulin action
• Reduction of insulin resistance
• Decrease in glycated hemoglobin
The cardiovascular system
• Decrease in blood pressure
• Improvement of the lipid balance
• Reduced risk of cardiovascular complications
The distribution of fats
• Weight loss in case of excess weight, or maintenance of a satisfactory weight
• Reduction of abdominal fat
Physical and moral well-being
• Maintains and improves bone strength
• Increase in muscle mass
• Reduction of stress and anxiety
• Creation of social links, improvement of the quality of life and well-being

If practiced regularly and with moderate intensity, physical activity can reduce the risk of complications associated with type 2 diabetes by 30 to 50%.

Risks and precautions
For more sustained physical activity (sports, intense gardening, housework, etc.), certain precautions should be taken. Unusual physical activity can cause hypoglycemia, especially if you are being treated with oral hypoglycemics and/or insulin.

Some symptoms of hypoglycemia can be confused with normal activity-induced reactions (e.g., sweating). The only way to tell the difference is to measure blood glucose. The risk of hypoglycemia is higher if the duration of the activity increases or if the activity is unplanned or not
adequately compensated with sugar.

We suggest that you consult your general practitioner or a nutritionist to plan the introduction of an athletic activity and to ensure safe control of your blood sugar. However, there are some tips that we can give you.
Before starting the activity:
– Take your blood glucose meter, fast-absorbing sugars, and a snack with you.
– Check your blood glucose before starting the physical activity, then check regularly as directed by your
caregiver. If blood glucose is between 4 and 5 mmol/L before starting, take 15 g of carbohydrates, then again every 30 to 45 min, if necessary.
– Monitor blood sugar levels more regularly for up to 24 hours after physical activity, especially if the activity was prolonged (ski touring, long walks, etc.)

Whether you live with diabetes or not, physical activity plays an important role in promoting good health and preventing various diseases. Physical activity allows:
• Better weight control;
• Decreased risk of osteoporosis and arthritis;
• Reduced risk of cardiovascular disease (reduction in short and medium-term blood pressure, blood cholesterol and blood triglyceride levels);
• Reduced stress and increased self-esteem;
• Increased energy level, improved physical fitness, and a feeling of well-being;
• Improved self-confidence and quality of life;
• Slowing down the development of peripheral neuropathy.

In general, regular physical activity reduces the risk of morbidity and mortality in the medium and long term.

We advise you to consult these sites for more information: