Management of Diabetes - Lifestyle and Exercise/Healthy Living Flashcards
What do we mean by a “healthy lifestyle” ?
Eat well balanced diet
Don’t smoke
Regular physical activity
Moderate alcohol use
Don’t use recreational drugs
Good work / life balance
Learn to deal with stress appropriately
Diagnosis of diabetes requires what change
Medication/Injections
Blood testing
Diet/weight loss
Physical activity
Dealing with hypos
Dealing with illness
Travel
Hobbies
Work
Family / friends
Why Diabetes Is So Hard?
Long term condition
Complex management
Lifestyle management
Delayed reward
Probabilistic reward
No symptoms ?
It does not fit in with life
what are the problems with young people and diabetes?
Desire to be same as peers
Sport
Nights out
Alcohol/Drugs
Learning to drive
Leaving home
Festivals
Travel
Sex/Contraception
Tattoos and piercings
Type 2 Diabetes - is it related to unhealthy lifestyles?
Increasing prevalence of obesity
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 are some dietary considerations in diabetes Type 1 and Type 2 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 carbohydrate counting in Type 1 Diabetes?
Quick acting insulin dose =
Dose to cover total carbohydrate in food
+
Correction dose if blood glucose high
How is glycaemic index and insulin related?
Composition of food alters how quickly carbohydrate is absorbed from gut
Adjustment of timing of insulin may be required for higher GI foods
Eating disorders and Type 1 diabetes - Diabulimia - what is it?
Diabulimia is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss
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 does smoking affect 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
Stopping smoking more beneficial than gaining a few kgs
Nicotine replacement and other drugs can be used in diabetes
how does recreational drugs affect diabetes?
Uppers/Downers/Hallucinogenics:
Risk of DKA (glucose production / hypos)
Seizures
Cardiotoxic
Anxious
Sick
Munchies
Hyper / hypotension
Advice:
Avoid
Avoid dehydration
Monitor glucose for highs and lows
Do not omit insulin/carbohydrate
Munchies and control
what is the burden of physical inactivity?
In the UK causes:
- 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
what is 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 is the key problem with exercise?
The key problem is that if exercise is not intrinsically satisfying, a person will seek to avoid it
