Managing diabetes

Question 1

What is meant by a healthy lifestyle?

Answer 1

○ 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

Question 2

What should a diabetic diet be?

Answer 2

○ No such thing as “diabetic diet”
○ Can eat simple carbohydrate in moderation
○ Poor evidence of different diets
○ Need to consider
- Consider need for weight loss
- Carbohydrate is main consideration in managing glycaemic control
- Also consider effects of diet on lipids / blood pressure

Question 3

What are the guidelines for healthy eating?

Answer 3

○ Avoid missing meals too often
○ Include starchy carbohydrate at each meal (whole grains)
○ Eat fruit and vegetables 5 servings
○ Include more beans and lentils
○ 2 portions oily fish
○ Limit sugar and sugary foods
○ Reduce salt to 6g or less (1 tsp)
○ 3 portions of dairy / alternative
○ Low saturated fats
○ Avoid diabetic foods

Question 4

Explain carbohydrate counting

Answer 4

○ Quick acting insulin dose=
- Dose to cover carbohydrate in food
PLUS
- Correction dose if blood glucose high

Question 5

Explain eating disorders and type 1 diabetes (diabulimia)

Answer 5

○ Relatively common
○ Usually associated with poor glycaemic control
○ Recurrent DKA
○ Insulin omission
○ High morbidity and mortality

Question 6

What happens when diabetics consume alcohol?

Answer 6

○ 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 e.g. dancing

Question 7

Explain smoking and diabetes

Answer 7

○ 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

Question 8

What happens when diabetics use recreational drugs?

Answer 8

• Risk of DKA (glucose production / hypos)
• Seizures
• Cardiotoxic
• Anxious
• Sick
• Munchies
• Hyper / hypotension

Question 9

What is the advice to diabetics in regards to recreational drugs?

Answer 9

• Avoid
• Avoid dehydration
• Monitor glucose for highs and lows
• Do not omit insulin /carbohydrate
• Munchies and control

Question 10

Why should we exercise?

Answer 10

• 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

Question 11

What are the recommendations for exercise for the general population?

Answer 11

- 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
- Consider sedentary time

Question 12

What is the advice for diabetics and exercise?

Answer 12

• reduce insulin before and after (up to 24 hours)
• Reduction hypo risk
• eat more (appropriate carbohydrate)
• use different insulin regimen (maximise flexibility)

Question 13

What is the advice for diabetics and driving?

Answer 13

○ 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 i.e. bus lorry - strict medical review
○ Take CHO in vehicle and test if on insulin
○ Do not drive for 45 mins after hypo
○ 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