Management of Diabetes: Lifestyle Flashcards
What contributes to healthy living?
- Exercise
- Diet
- Health
What do we mean by healthy living?
- Eat well balanced diet
- Don’t smoke
- Regular physical activity
- Moderate alcohol use (little and often?)
- Don’t use recreational drugs
- Good work/life balance
- Learn to deal with stress appropriately
What must be considered when living with diabetes lifestyle wise?
- Medication/injections
- Blood testing
- Diet/weight loss
- Physical activity
- Dealing with hypos
- Dealing with illness
- Travel
- Hobbies
- Work
- Family/friends
Why is living with diabetes so hard?
- Long term condition
- Complex management
- Lifestyle management
- Delayed reward
- Probabilistic reward
- No symptoms?
- It does not fit in with life
What issues may a young person with diabetes encounter?
- Desire to be same as peers
- Sport
- Nights out
- Alcohol/drugs
- Learning to drive
- Leaving home
- Festivals
- Travel
- Sex/contraception
- Tattoos and piercings
In what way is T2DM related to unhealthy lifestyles?
- Increasing prevalence of obesity
- Type 2 diabetes is an obesity related disease
- Physical activity can prevent diabetes onset
- Smoking increasing risk of diabetes
- Alcohol excess increases risk of diabetes
- But not everyone gets diabetes (genes can’t be changed)
How does diabetes affect someone’s diet?
- No such thing as ‘diabetic diet’
- Can eat simple carbohydrate in moderation
- Poor evidence of different diets
What dietary considerations are there in diabetes management?
- Consider need for weight loss
- Carbohydrate is main consideration in managing glycaemic control
- Also consider effects of diet on lipids / blood pressure
What is healthy eating?
- Avoid missing meals too often
- Include starchy carbohydrate at each meal (wholegrains)
- Eat fruit and vegetables (5 servings)
- Include more beans and lentils
- 2 potions of oily fish per week
- Limit sugar and sugary foods
- 3 portions of dairy/alternative
- Low saturated fats
- Avoid diabetic foods
How is carbohydrate counting related to insulin doses?
-Dose to cover CHO in food = quick acting insulin dose
+
-Correction if blood glucose high
What eating disorder is associated with T1DM?
Diabulimia
What is diabulimia associated with?
- Relatively common
- Usually associated with poor glycaemic control
- Recurrent DKA
- Insulin omission
- High morbidity and mortality
What alcohol guidance should diabetics stick to?
- Same limit as general population
- More than 2-3 units at one time increases hypo risk
- Advise to eat before and snack at bedtime
- Note other activity at time of alcohol eg dancing
Why is alcohol followed by a rise then fall in glucose?
Alcohol contains calories
What does alcohol reduce?
Glycogenolysis
What risks does smoking carry?
- Smokers die 10 years before non-smokers
- 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
- Stopping smoking more beneficial than gaining a few kgs
- Nicotine replacement and other drugs can be used in diabetes
What risks do uppers/downers/ hallucinogenics carry, particularly in diabetes?
- Risk of DKA (glucose production / hypos
- Seizures
- Cardiotoxic
- Anxious
- Sick
- Munchies
- Hyper / hypotension
If someone with diabetes is going to engage in recreational drug use what advice should they follow?
- Avoid
- Avoid dehydration
- Monitor glucose for highs and lows
- Do not omit insulin /carbohydrate
- Munchies and control
What pathological burden for physical inactivity cause in the UK?
- 10.5% of coronary heart disease cases
- 18.7% of colon cancer cases
- 17.9% of breast cancer cases
- 13.0% of type 2 diabetes cases
- 16.9% of premature all-cause mortality
What are the benefits of exercise?
- Cardiovascular benefit
- Reduces cancer risk
- Consumes energy
- Builds lean tissue and consumes fat
- Improves strength, endurance, balance and flexibility
- Improves mood and self esteem
- Can be sociable
What are the recommended levels of exercise for the general population 16-75?
-Moderate exercise 2.5 - 3 hours per week translates into a 30% reduction in most major diseases.
OR
Vigorous exercise 75 mins per week
PLUS
-Strength training on 2 or more days
- More exercise is more protective
- Children should do 60mins / day
How do we help people increase physical activity levels?
-Talk to them about it: What do they enjoy, Why don’t they do it, Opportunities -Provide facilities -Social / work place structure -Community involvement -Schools etc -Councils/Government strategies
What is the advice for diabetics when exercising?
Exercise (encourage all to do):
- Reduce insulin before and after (upto 24 hours)
- Reduction hypo risk
- Eat more (appropriate carbohydrate)
- Use different insulin regimen (maximise flexibility)
What are the guidelines regarding driving with diabetes?
- Risks of hypos, poor vision, neuropathy
- Can drive with diabetes
- Inform DVLA if on insulin
- Since November 2011 allowed to apply for Group 2 licences if on insulin ie bus lorry - strict medical review
- Take CHO in vehicle and test if on insulin
- Do not drive for 45 mins after hypo
What are the guidelines regarding driving and hypoglycaemia?
Patients should be advised to check their blood glucose within 2 hours of starting driving and 2 hourly during long car journeys and should always carry carbohydrate in the car.
What are the absolute exclusions for those with diabetes and employment?
- Armed forces
- Police
When is it up to the employer if they employ someone with diabetes?
- Offshore oil limited but increasing
- Blue light rapid response drivers
Give examples of hobbies/employment to consider carefully if diabetic
- Scuba diving
- Scaffolder / window cleaner
- Solo yachtsman / women
- (Endurance sports)
- Taxi- driver
- Emergency vehicle driver
- Bus / lorry driver
What considerations is there for diabetics when going on holiday?
- 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)
- Adjust insulin to cross time zones
