Lifestyle + exercise + self-management of Diabetes Flashcards
What sorts of things get in the way of managing a long term health condition (5)
Emotional well-being
Motivation
Importance
Health beliefs
Experiences
What is the national target for Type 1 diabetic glycaemic control
HbA1c level of 48 mmol/mol (6.5%) or lower
but everyone will have slightly different target - hard to keep it at national target
What is the secondary care HADS screening? What were the results
14 item outcome that measures anxiety and depression involvement with diabetes
15% anxiety
10% depression
8% both
Psychological issues associated with diabetes (4)
Anxiety & Stress
Depression & Low Mood
Adjustment problems
Eating-related & body image difficulties
all can lead to poor control
Why is stress so bad with diabetes
Stress makes blood glucose levels rise
This is because cortisol kicks in (fight or flight response) to raise energy for the body to survive and get away
Anxiety and diabetes
Worry; nausea; < focus; restlessness; shaking; muscular tension; sweating; avoidance
General anxiety (unrelated to diabetes) or Hypo fear
Deposits glucose in the blood + reduced insulin efficiency – stress reactivity varies though
What are some health beliefs?
The following tend to make a patient more active in controlling their disease:
knowing the seriousness of a condition
effectiveness of treatments
costs and benefits of following advice
self efficacy
vulnerability to future problems
impact of illness
What is the ABC of behaviour
Antecdents - situations, thoughts, feelings preceding
Behaviour - Target behaviour
Consequences - short, medium, + long term
Why might a patient not check their glucose levels
Not great readings make them feel anxious & not good enough
Don’t want to have to inject theirselves with needles
Example of ABC method of behaviour
A - Working in shifts, get home late, sick of having to deal with diabetes when others don’t, feeling angry and frustrated
B - Don’t take insulin
C - Short term - anger dissipates
Later -Wake up in the morning groggy, check blood glucose – very high, spend most of the day trying to balance and correct levels - more anger and frustration
How can we break well established habits in our behaviour
Stress reducing techniques
Online self-help/psychology/mindfulness
Involve key people in behaviour change
Friends; family; HC Practitioner
Use prompts – apps, alerts on phone
Importance (0-10) if important will be motivated to change; if not important then unlikely to change
Confidence in changing (0-10)
Behavioural changes can have what outcome?
Prevent disease
improve disease management
improve QOL
Why is diabetes so hard? (7)
Long term condition
Complex management
Lifestyle management – maintaining it is difficult
Delayed reward – good control reduces chance of complications but thinking ahead purely for benefits in the future is hard
Probabilistic reward – may still get complications, not 100% guaranteed.
No symptoms ? - can’t always tell when it is getting bad
It does not fit in with life - interferes with daily living
Why is diabetes specifically hard for young people? (10)
Desire to be same as peers Sport Nights out Alcohol / Drugs Learning to drive Leaving home Festivals - need to keep medication chilled Travel Sex / Contraception - don't want to get pregnant with uncontrolled diabetes Tattoos and piercings - impaired healing
How does an unhealthy lifestyle link in with type 2 diabetes
Type 2 Diabetes is an obesity related disease
Physical activity can prevent diabetes onset
Smoking increases risk of diabetes
Alcohol excess increases risk of diabetes
What is the main consideration in managing glycaemic control?
Carbohydrate intake
Mediterranean diet model
Regular physical activity
H20 and herbal infusions good
Every main meal - fruit and veg. Olive oil, bread/pasta/rice/cous cous
Every day - dairy and olives/nuts/seeds. Herbs/spices/garlic/onions
Weekly - potatoes, white meat, red meat, eggs, sweets
Describe a healthy food plate
1/3 fruit and veg
1/3 bread/rice/potatoes/pasta
last third split up between meat,fish,eggs,beans
food + drinks high in fat or sugar
milk and dairy foods
What is the glycaemic index
Shows how quickly carbohydrate gets from your gut into your bloodstream
If it has a high GI then you get a peak in your [BG]
Adjustment of timing of insulin may be required for higher GI foods
Why do T1 diabetic patients do carbohydrate counting
To work out how many carbohydrates they are about to eat in order to know how much insulin to take before the meal and whether they need a correction dose if their BG is already high
Examples of some foods with high carbohydrate content
Cola
Jelly babies
Wine gums
Orange juice
Examples of some foods with low carbohydrate content
Butternut squash Cherries Grapefruit Lentils Parsnips Peas
What is Diabulimia
An eating disorder associated only with T1 diabetes
When someone stops taking their insulin to lose weight (No insulin - Glucose isn’t taken into fat cells to either be used or stored as fat)
Can result in recurrent DKA’s
Relatively common - affects 20% of women
High morbidity (poor control) and mortality
Alcohol and diabetes
Alcohol reduces glycogenolysis (break down of glycogen stores - reduction in glucose)
Alcohol contains calories - results in a rise followed by a fall in glucose
Diabetics have the same limit as general population - more than 2-3 units at one time increases hypo risk
Advice is to have big meal before and a snack on way home or before bed
Smoking and diabetes
Smoking increases risk of diabetes 1.5 times
Smoking increases risk of macrovascular disease (at least doubles)
People with diabetes at risk of ischaemic heart disease
Smoking increases risk of all complications
Nicotine replacement and other drugs can be used in diabetes
Recreational drugs and diabetes
For uppers/downers and hallucinogenics:
Risk of DKA is much higher Seizures Cardiotoxic Anxious Sick Munchies Hyper/hypotension
Cognitive impairment - not going to be treating your diabetes in correct way
Burden of physical inactivity: UK statistics
- 5% of coronary heart disease cases
- 7% of colon cancer cases
- 9% of breast cancer cases
- 0% of type 2 diabetes cases
- 9% of premature all-cause mortality
Why shouldn’t you exercise straight after taking rapid acting insulin?
Rapid acting - causes quick drop in [BG]
During exercise – body burns glycogen – glucose released from glycogen stores basically – GB goes up at first
After exercise your muscles replenish their glycogen stores with glucose from the blood – drop in BG - even bigger due to first drop from insulin injection
more at risk of hypo
What should you do if you’ve had a hypo in the last 24hrs (severe or not severe)
severe - do not exercise
not severe - risk of a hypo is higher so take extra precautions and don’t do lone events on that day
What type of exercise is best for T1 diabetics
A mix of aerobic (BG decreases) and anaerobic (BG increases)
How should a type 1 diabetic prepare for exercise
Reduce their insulin before and after (up to 24hrs)
Eat more - appropriate carbohydrate - reduce risk of hypo
reduce hypo risk - sprint at the end of exercise reduces this
Driving and diabetes
Risk of hypos, poor vision, neuropathy (loss of sensation)
You can drive with diabetes but you must inform DVLA if you are on insulin
Since November 2011 allowed to apply for Group 2 licences if on insulin ie bus lorry - strict medical review
MUST WAIT 45 MINS AFTER HYPO TO START DRIVING AGAIN
SHOULD CHECK BG WITHIN 2 HOURS OF STARTING DRIVING
Work/employment and insulin treated diabetes
Disability Discrimination Act 2010
Absolute exclusion - cannot work in the police or armed forces
Offshore work or blue light rapid response drivers may be off limits
Travel and diabetes
No restrictions but use common sense and insurance premium
Monitor glucose
Drink plenty of fluids
Avoid risks of gastroenteritis
Always carry insulin with you (not hold luggage)
Adjust insulin to cross time zones
