Lifestyle Modifications in Diabetes

Diabetes is a chronic metabolic disease. In which your blood glucose is higher than the normal range. There are three main types of diabetes, namely Type 1, Type 2, and gestational diabetes. More glucose in the blood leads to polyuria (increased urination), polydipsia (increased thirst). Defect in diabetes lies at the cellular level, where glucose is not effectively utilized by cells.

Why is it important to treat diabetes?

It is essential to treat high blood glucose levels in diabetes because it leads to many complications, e.g., diabetic nephropathy (kidney failure), diabetic retinopathy (vision loss), diabetic neuropathy (sensation loss), foot ulcers, diabetic cardiomyopathy (heart disease).

Early treatment and better glucose control are essential things in diabetes management. As far as diabetes treatment is concerned, lifestyle modifications and pharmacological therapies play an important role.

Lifestyle modification is very much neglected yet to be a useful measure for the treatment of diabetes.

Anti-diabetic drugs should not be a replacement for lifestyle modification, but it should complement it.

I have seen many people with diabetes who are on anti-diabetic drugs and eat whatever they want! No control over their food. This should not be acceptable when you have diabetes or pre-diabetes.

American Diabetic Association (ADA) guidelines recommend lifestyle modifications as a first-line treatment for type-2 diabetes. Many studies have shown the potential of reducing HbA1C by lifestyle modifications.

How COVID era affects diabetes?

The novel coronavirus causes COVID-19 significantly affected the mindset of the people. It creates fear, stress, and depression in people’s life. Stress causes the release of stress hormone that causes an increase in blood glucose level and blood pressure. Superadded lockdown and social distancing cause an increase in stress levels. Therefore, in this crucial time, one should take care of essential lifestyle modifications and sanitation measures to prevent diabetes and COVID-19.

Lifestyle modifications for diabetes include

1. Diet plan:

What you eat directly affects the blood glucose level. People with diabetes should have a proper diet plan to control blood glucose levels. Consultation with a dietitian is recommended to have an appropriate diet plan. There is no universal diet plan, but the emphasis should be put on an individual diet plan. Beneficial dietary changes include increasing consumption of dietary fiber, vegetables, and wholegrain foods.

Minimize adding extra sugars and refined grains. Calorie restriction should be done via eating in small meals rather than a big heavy meal. Studies have shown the benefit of carbohydrates consumption and its ability to reduce HbA1C of 0.2-0.5%. Decrease intake of fat, particularly saturated fat, is recommended. Avoid junk food and processed food, foods high with salt, sweets, beverages with added sugars.

ADA recommends limiting sodium intake to <2300 mg per day, which is 1 teaspoon of table salt per day. American Heart Association (AHA) recommends further restrict sodium to 1500 mg/day for those at risk of heart disease and hypertensive patients.

2. Physical activity:

Benefits of it include reduction of cardiovascular risk factors, weight loss, improvement of well-being, and glucose control. Moderate to a high amount of aerobic activity lowers cardiovascular and overall mortality risks in type 1 and type 2 diabetes mellitus.

A well-planned exercise of 8 weeks duration has been shown to reduce HbA1C by 0.66% in people with type2 diabetes. Children and adolescents with pre-diabetes or type 1 or type 2 diabetes should engage in ≥60 min/day of moderate or vigorous aerobic exercise.

Adult people with type 1 or type 2 diabetes should engage in ≥150 min/week of moderate to vigorous aerobic exercise that should be spread over at least 3 days/week. There should not be any >2 consecutive days without exercise. For younger and physically fit people, the vigorous exercise a minimum of 75 min/week may be sufficient. People with type 2 diabetes should avoid sedentary behavior, and prolonged sitting should be interrupted every 30 min by standing for 5 min for better control of blood sugar.

3. Weight loss:

Obesity is known to cause insulin resistance, type 2 diabetes, and metabolic syndrome. So for reducing the risk of developing diabetes and better blood glucose control, weight loss is recommended.

The overweight individual should plan to reduce their weight and maintain their BMI within the normal range. Sustained weight loss has its long-term advantages, including improvement in HbA1C and lipid levels.

For weight loss, one should have an energy deficit of 500-750 kcal/day. Therefore, 1200-1500 kcal/day for women and 1500-1800 kcal/day should be adjusted for baseline body weight. For obese people with diabetes, a minimum of 5% of weight loss should be required to have beneficial effects on BP, glucose control, and lipid levels.

4. Avoid smoking and drinking alcohol:

Smoking is a well-known risk factor for diabetes and cardiovascular diseases. Smoking increases diabetes risk by 30-40%. The use of tobacco and e-cigarette should be avoided. Alcohol stimulates the appetite so that you will eat a lot. Ultimately, it will affect your glucose control and increase blood pressure.

5. Stress management:

Reduce stress by doing yoga, meditation, and involve yourself in pleasant activities.

6. Foot care:

Due to diabetic neuropathy, people with diabetes lose sensation in the foot that may result in unnoticed injury, and ulceration. The high glucose level in diabetes leads to non-healing of the wound, so foot care is very important. ADA recommends the use of specialized therapeutic footwear for high-risk patients with diabetes.

In a nutshell, diabetes education plays a major role in improving self-care in diabetes. One should not forget the role of lifestyle modifications in diabetes treatment.

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