Lifestyle changes in diabetes form an integral part of managing the condition.
When it comes to managing type 2 diabetes in India, it is not just the medicines that matter. Certain goals with respect to nutrition and exercise have to be set and achieved.
Lifestyle Changes in Diabetes
In this article, I’m going to briefly discuss medical nutrition therapy (MNT), exercise protocols and other lifestyle changes that must be followed when managing type 2 diabetes.
Medical Nutrition Therapy
When it comes to lifestyle changes in diabetes, there is no ‘one diet fits all’ strategy. Individualized medical nutrition therapy is always recommended.
In other words, every patient should have a specific diet discussed with them. This can be done by their doctor or their dietitian.
What Are The Goals Of Diet Therapy In Diabetes?
The primary goal of diet therapy in diabetes is to reduce blood sugar values and to prevent complications of diabetes.
Studies have found that simple dietary changes alone can reduce the HbA1c value by 0.5 to 2%.
Diets have to be tailor-made and portion sizes have to be controlled so as to achieve and maintain a weight loss goal of around 5 – 7% percent of the existing body weight.
For example, if you weigh 70 kg, losing around 3.5 – 5 kg itself can reduce your risk significantly.
However, when doing so, personal and cultural preferences must be taken into account. There are festival seasons when dietary habits can be very difficult to control.
That being said, some degree of restraint must be practiced to prevent blood sugar spikes after high-carbohydrate meals during these functions.
Simple Steps Make A Difference
It is well known then a diet that is high in carbohydrates, especially refined carbohydrates, is harmful in diabetes.
I have already discussed some of the foods that you must avoid in diabetes elsewhere on this blog.
Choose diets that have a higher concentration of unrefined carbohydrates and fiber.
Examples include legumes, nuts and unprocessed vegetables.
I generally advise patients to have one fruit of their choice per day except for mango and jack fruit as these tend to be higher in sugars.
With regards to vegetables, avoiding potato (but not sweet potato) can be beneficial in keeping sugars under control.
The total protein intake every day should be around 15% of the total calories that are consumed.
Choose more green leafy vegetables, vegetable salads, sprouts, and even spices as they are rich in fiber and full of antioxidants.
When choosing dairy products, you could consider low-fat milk and milk products and even cottage cheese (paneer). However, consume these in moderate amounts.
The intake of mixed vegetable oils has been found to be more beneficial compared to individual oils. In a recent meeting in New Delhi, I remember a professor of cardiology from the All India Institute Of Medical Sciences discussing mixed oils as being healthier than using a single type of oil.
These days, these kinds of oils are widely available in supermarkets.
If you wish to eat non-vegetarian food, you could choose lean meats such as chicken and fish. Egg whites are full of protein and have a high bio-availability. Avoid red meat if you can.
Of course, you will be very well aware that consuming sugary items is a complete no-no in diabetes.
Alcohol can be had in moderation, but if possible avoid it completely. Avoid processed foods and foods that are deep-fried and rich in salt.
If you wish to learn more about diet in diabetes, make sure you speak to your doctor or a registered dietitian. Bear in mind that dietary modifications are an essential part of lifestyle changes in diabetes.
Physical Activity In Type 2 Diabetes
There is a big difference between physical activity and exercise.
Physical activity is what we all do when our day-to-day lives – walking around the house, driving to work, having a bath, washing the vessels, doing the laundry etc.
Exercise is completely different.
Exercise includes activities such as brisk walking for 30 to 40 minutes, jogging, swimming, cycling and even strength training using different equipment and weights. During exercise, the heart rate and blood pressure go up. Breathing rate increases as well.
How Does Exercise Help?
When you exercise, your body utilizes the glucose that is present in the bloodstream a lot better.
This is because the muscles require a lot more fuel for energy from the glucose that is present in the blood for intense activity. In addition to that, the insulin sensitivity of the tissues improves dramatically.
This means that insulin is able to bind to glucose a lot better allowing the glucose to enter the muscles and all vital tissues in a more reliable and predictable manner.
There is always a concern about low blood sugars during exercise.
The risk of exercise-induced hypoglycemia is very minimal in general. However, if you are on insulin, just keep an eye on for your sugars during exercise. If necessary, you can check your blood sugar prior to going for a walk to ensure that it is not in the low-normal range.
There is some clinical evidence that combining both aerobic exercises with the strength training may be more effective in improving the control of blood glucose. When it comes to weight loss, this is a proven strategy. But this may not entirely be the case in the management of diabetes.
That being said, I still strongly advise patients to do both aerobic exercise and strength training along with yoga as well.
It is important to bear in mind that it is not just short-term exercise that matters but long-term exercise that will have the maximum benefit on blood sugar control.
By increasing muscle mass and reducing body fat, you improve blood glucose levels and enhance glycaemic control in a remarkable fashion.
In the long term, this will lower your chances of developing a heart attack or stroke.
It is currently recommended that all individuals making lifestyle changes in diabetes undertake at least 150 minutes per week of moderate to vigorous aerobic exercise. This should be spread out over 3 to 5 day period.
Bear in mind however that the cardiovascular benefits of exercise wear off after 48 hours of stopping exercise. This means that you have to exercise at least every alternate day to keep your blood sugars under control and your heart healthy.
I will be discussing exercise and diabetes in a lot more detail in a separate post at some point.
There are rarely any situations where exercise in diabetes should be done with caution.
In those individuals who are taking insulin or insulin-like drugs, the risk of low blood sugar i.e. hypoglycemia exists during exercise.
Always make sure the blood sugar levels are about 100 mg/dL or above prior to exercise. If your sugars are low, consume a carbohydrate-rich meal before you go for a walk or any other exercise.
There are some individuals who may have developed other contexts of diabetes that can make it difficult for them to exercise.
For example, individuals in whom diabetes affects the eye i.e. (diabetic retinopathy), vision may be a problem. Vigorous exercise may affect the back of the eye leading to a condition called vitreous haemorrhage or retinal detachment.
In those in whom the nerves are affected (i.e. peripheral neuropathy) in diabetes may experience reduced pain sensation in the feet. In addition to this, they may develop a joint problem called Charcots arthropathy which is a painful condition.
Dry skin is a problem and cracks in the feet can allow bacteria to enter the and cause infections. It is strongly recommended for all individuals with peripheral neuropathy or with diabetes in general to wear shoes when exercising.
Sedentary behavior should be completely avoided if you have diabetes. In fact, it is recommended that long sitting should be interrupted every 30 minutes in order to maintain blood sugar levels.
Some have even gone to the extent of saying that standing is better than sitting when it comes to overall health.
Challenges In Lifestyle Modifications In Diabetes
There are a number of challenges both patients and doctors face when it comes to managing diabetes mellitus through lifestyle changes.
Low health literacy is a common problem and a poor understanding of diabetes itself and its complications exists. Education is key.
After an initial diagnosis of diabetes is made, many individuals are enthusiastic about making lifestyle changes.
However, as time passes, this becomes a problem as life just gets in the way. Low motivation becomes a big issue and can greatly affect blood sugar levels.
There are of course numerous social and cultural factors around exercise. Having a safe environment is important and the result is a concern that walking or running on the road to a dog chase!
Festivals and weddings are an integral part of our Indian culture. It is hard not to partake in sweet and savory items when a loving host of them to us.
One piece of advice I usually give patients is to cut down on the portion size of the food they eat at other meal times if they are aware that they are attending an event that day.
Finally, our busy lifestyles mean that we hardly get any time to exercise. That fact notwithstanding, dietary measures can still be followed stringently if needed.
It Is Just Baby Steps
It can take time to make lifestyle changes in diabetes. No one is expected to make a drastic change within a short time.
Here are some simple steps can help you tackle diabetes through lifestyle changes.
- Make note of your goals when it comes to health. For example, walk 10000 steps every day for five days a week. Use a pedometer or a mobile phone app if you wish to do so.
- If walking or running is not your thing, try and join an exercise program that is a lot more fun. Zumba and bhangra dancing seems to be quite popular these days.
- Ask your family members to be a part of your diet and exercise journey. Having a partner can help tremendously.
- Keep positive mental attitude. Remember that there is always help and and diabetes can controlled provided you have the determination to keep your habits under control. Making excuses every time you have to diet and exercise is not going to help anyone and is going to cause you more harm.
Lifestyle changes in diabetes are not difficult. Taking the right steps early on can help delay or even prevent complications in the future.
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