[Why does nutrition therapy so often fail in non-insulin-dependent diabetes? What measures bring success?]

It is a common belief among physicians that nutritional therapy in type II diabetic subjects is inefficient because the patients do not comply with the recommendations. Failure of a therapeutic response leads to feelings of guilt in patients, followed by frustration, and refusal of further treatment. The physician rapidly starts with drug or insulin therapy before the effects of diet treatment are assessable. Nutritional recommendations for diabetics are basically the same as for non-diabetics. Successful dietary treatment of obese type II diabetic subjects requires realistic goals regarding weight loss. Frequent mistakes are that an ideal body weight is aimed for, and that the patients are asked to omit only carbohydrates in the diet. Splitting of the meals, and distribution of carbohydrate-containing foods to individual meals during the day are important components of a meal plan. The patient should also be counciled how to avoid visible and invisible dietary fats. Exchange lists are frequently administered, but they fail, because they are too complicated. Only a part of decompensated type II diabetic subjects respond to weight loss. The response is evident already after a few [2.3 kg] weight loss. Other diabetic subjects fail to improve their glucose control after weight loss. These patients require an alternative treatment, i.e. oral antidiabetic agents or insulin. Frequently behavior therapy is of advantage in obese type II diabetic subjects, in addition to longterm dietary treatment. Dieticians should be involved in all difficult cases since they have the necessary experience to perform this longterm treatment.