Management of Diabetes: Lifestyle and Exercise/Healthy Living Flashcards
what is the WHO definition of a healthy lifestyle?
A healthy lifestyle is a way of living that lowers the risk of being seriously ill or dying early… Health is not only just about avoiding disease. It is also about physical, mental and social wellbeing
what occurs when excersize, mental and physical health become disrupted?
what can poorer physical health lead to?
what is the basic 5-areas approach?
what makes up a healthy lifestyle?
Good nutrition / weight
Not smoking
Regular physical activity
Moderate alcohol use
Not using recreational drugs
Good work / life balance
Learn to deal with stress appropriately
diagnosus of diabetes requires a change in lifestyle how can this be done?
Medication / Injections
Blood testing
Diet / weight loss
Physical activity
Dealing with hypos
Dealing with illness …
Travel
Hobbies
Work
Family / friends…
why is diabetes so hard for patient?
Long term condition
Complex management
Lifestyle management
Delayed reward
Probabilistic reward
No symptoms ?
It does not fit in with life
what challenges do young diabetes patients face?
Desire to be same as peers
Sport
Nights out
Alcohol / Drugs
Learning to drive
Leaving home
Festivals
Travel
Sex / Contraception
Tattoos and piercings ….
what impact does deprivation have on healthy living?
UK’s poorest 2.5 x as likely to have diabetes
Higher risk of obesity
Doubles risk of complications
Healthy behaviours may seem unattainable
eg cost of foods / gym membership
Food poverty
Drug use
Access to Physical activity resources
Lower uptake of education and technologies to support diabetes
Poorer clinic attendance
what is the prevalence of diabetes in scotland?
what are some common myths about diets and diabetes?
You should eat a “diabetic diet”
Can’t eat simple carbohydrate
what are dietary considerations for type 1 & 2 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 does the eatwell guide look like?
what does a mediterrainian diet look like?
what is the glycaemic index?
a way of ranking carbohydrate-containing foods based on how slowly or quickly they are digested and increase blood glucose levels over a period of time – usually 2 hours. The GI uses glucose or white bread as a reference food – it has a GI score of 100.
what do higher GI foods include?
white bread.
corn flakes.
fruit juice.
instant noodles.
rice cakes.
potatoes.
what has a low glycaemic index?
Low GI : Green vegetables, most fruits, raw carrots, kidney beans, chickpeas and lentils.
Medium GI : Sweet corn, bananas, raw pineapple, raisins, cherries, oat breakfast cereals, and multigrain, whole-grain wheat or rye bread.
High GI : White rice, white bread and potatoes.
how does the glycaemic index affect insulin?
Composition of food alters how quickly carbohydrate is absorbed from gut
Adjustment of timing of insulin may be required for higher GI foods
how is type one diabetes related to an eating disorder?
Reducing insulin to control weight
May involve binging behaviours
Relatively common
Usually associated with poor glycaemic control
Recurrent DKA
Insulin omission (20% women omit insulin to control weight at some point)
High morbidity and mortality
how does alcohol affect diabetes?
Alcohol reduces glycogenolysis
Alcohol contains calories
results in rise followed by fall in glucose
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
how much does inactivity cost the nhs?
> £1 billion
what is the largest economic cost in high income countries?
The largest economic cost is set to occur among high-income countries, which will account for 70% of health-care expenditure on treating illness resulting from physical inactivity.
what diseases does WHO estimate physical inactivity count for?
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 excersize?
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
how does glucose respond to different types of excersize?
what is recommended to diaebetics on insulin before and after excersize?
reduce insulin before and after (upto 24 hours)
Reduction hypo risk
how much should diabetic patients excersizing eat?
eat more (appropriate carbohydrate)
use different insulin regimen (maximise flexibility)
if you have had a severe hypo in the last 24 hours should you excersize
NO
what do different blood glucose levels mean before excersizing?
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
what diabetic specific barriers should be discussed in helping increase physical levels?
Address diabetes specific barriers:
Fear of hypos / insulin adjustment / lack of knowledge / nutrition
what can be provided to help people increase physical activity levels?
Use tech eg step counters / activity monitors +apps
Provide facilities / Social / work place structure
Community involvement / Schools etc
Councils / Government strategies
what impact can too much sedentary time have on an individual even if they have done excersize that day?
Independent of recommended PA levels
Increases risk of:
obesity
Doubles T2 diabetes risk
Some cancers
CV events
all cause mortality
Get up regularly
Workplace / Home
what impact does smoking have on diabetes?
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
will stopping smoking have an impact on weight change?
Stopping smoking more beneficial than gaining a few kgs
Nicotine replacement and other drugs can be used in diabetes
what is the prevalence of diabetic smokers in scotland?
what are the risks of using recreational drugs whilst you have diabetes?
Risk of DKA (glucose production / hypos)
Seizures
Cardiotoxic
Anxious
Vomiting
Munchies
Hyper / hypotension
what is the advice on recreational drugs for diabetic patients?
Avoid
Avoid dehydration
Monitor glucose for highs and lows
Do not omit insulin /carbohydrate
Munchies and control
what can cause diabetic patients risks when driving?
Risks of hypos, poor vision, neuropathy
what must a diabetic patient do if they plan to drive?
Can drive with diabetes
Inform insurance
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
how long after a hypo are you allowed to drive?
Do not drive for 45 mins after hyp
what should diabetic patients do within 2 hours of starting driving?
Patients should be advised to check their glucose within 2 hours of starting driving and 2 hourly during long car journeys and should always carry carbohydrate in the car.
in cars how should patients manage diabetes?
Cars – CGM or flash monitoring of blood glucose
what must be monitered in group two vehicles?
Group 2 vehicles – blood glucose
how is work / employement affected by diabetes?
what exclusions are there?
Equality Act 2010
Reasonable adjustments
Some exclusions:
Armed forces (exempt from Equality Act)
Emergency services –depends on service
Up to employer / individual
Eg offshore oil
Shipping
Blue light rapid response drivers
Driving restrictions
how does work affect diabetes?
At diagnosis of Type 1 we recommend 2 weeks off
Monitoring glucose levels and injecting in the workplace
Access to phones
Time off for appointments / education
Hypos at work / make treatment available
Time for breaks and testing etc
what are some hobbies / work to consider carefully before doing with diabetes?
Scuba diving
Scaffolder / window cleaner
Solo adventures / activities
Endurance sports
Taxi- driver
Emergency vehicle driver
Bus / lorry driver
Game keeper
how should diabetes be controlled with holidays?
No restrictions but use common sense and insurance
Monitor glucose (and ketones)
Drink plenty of fluids
Avoid risks of gastroenteritis
Know sick-day rules
Always carry insulin with you (not hold)
Adjust insulin to cross time zones
