Management of Diabetes: Lifestyle and Exercise/Healthy Living

Question 1

what is the WHO definition of a healthy lifestyle?

Answer 1

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

Question 2

what occurs when excersize, mental and physical health become disrupted?

Answer 2

Question 3

what can poorer physical health lead to?

Answer 3

Question 4

what is the basic 5-areas approach?

Answer 4

Question 5

what makes up a healthy lifestyle?

Answer 5

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

Question 6

diagnosus of diabetes requires a change in lifestyle how can this be done?

Answer 6

Medication / Injections
Blood testing
Diet / weight loss
Physical activity
Dealing with hypos
Dealing with illness …
Travel
Hobbies
Work
Family / friends…

Question 7

why is diabetes so hard for patient?

Answer 7

Long term condition
Complex management
Lifestyle management
Delayed reward
Probabilistic reward
No symptoms ?
It does not fit in with life

Question 8

what challenges do young diabetes patients face?

Answer 8

Desire to be same as peers
Sport
Nights out
Alcohol / Drugs
Learning to drive
Leaving home
Festivals
Travel
Sex / Contraception
Tattoos and piercings ….

Question 9

what impact does deprivation have on healthy living?

Answer 9

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

Question 10

what is the prevalence of diabetes in scotland?

Answer 10

Question 11

what are some common myths about diets and diabetes?

Answer 11

You should eat a “diabetic diet”
Can’t eat simple carbohydrate

Question 12

what are dietary considerations for type 1 & 2 diabetes management?

Answer 12

Consider need for weight loss

Carbohydrate is main consideration in managing glycaemic control

Also consider effects of diet on lipids / blood pressure

Question 13

what does the eatwell guide look like?

Answer 13

Question 14

what does a mediterrainian diet look like?

Answer 14

Question 15

what is the glycaemic index?

Answer 15

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.

Question 16

what do higher GI foods include?

Answer 16

white bread.
corn flakes.
fruit juice.
instant noodles.
rice cakes.
potatoes.

Question 17

what has a low glycaemic index?

Answer 17

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.

Question 18

how does the glycaemic index affect insulin?

Answer 18

Composition of food alters how quickly carbohydrate is absorbed from gut

Adjustment of timing of insulin may be required for higher GI foods

Question 19

how is type one diabetes related to an eating disorder?

Answer 19

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

Question 20

how does alcohol affect diabetes?

Answer 20

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

Question 21

how much does inactivity cost the nhs?

Answer 21

> £1 billion

Question 22

what is the largest economic cost in high income countries?

Answer 22

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.

Question 23

what diseases does WHO estimate physical inactivity count for?

Answer 23

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

Question 24

what are the benefits of excersize?

Answer 24

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 25

how does glucose respond to different types of excersize?

Answer 25

Question 26

what is recommended to diaebetics on insulin before and after excersize?

Answer 26

reduce insulin before and after (upto 24 hours) Reduction hypo risk

Question 27

how much should diabetic patients excersizing eat?

Answer 27

eat more (appropriate carbohydrate) use different insulin regimen (maximise flexibility)

Question 28

if you have had a severe hypo in the last 24 hours should you excersize

Answer 28

NO

Question 29

what do different blood glucose levels mean before excersizing?

Answer 29

Question 30

how do we help people increase physical activity levels?

Answer 30

Talk to them about it: What do they enjoy Why don’t they do it Opportunities

Question 31

what diabetic specific barriers should be discussed in helping increase physical levels?

Answer 31

Address diabetes specific barriers: Fear of hypos / insulin adjustment / lack of knowledge / nutrition

Question 32

what can be provided to help people increase physical activity levels?

Answer 32

Use tech eg step counters / activity monitors +apps Provide facilities / Social / work place structure Community involvement / Schools etc Councils / Government strategies

Question 33

what impact can too much sedentary time have on an individual even if they have done excersize that day?

Answer 33

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

Question 34

what impact does smoking have on diabetes?

Answer 34

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

Question 35

will stopping smoking have an impact on weight change?

Answer 35

Stopping smoking more beneficial than gaining a few kgs Nicotine replacement and other drugs can be used in diabetes

Question 36

what is the prevalence of diabetic smokers in scotland?

Answer 36

Question 37

what are the risks of using recreational drugs whilst you have diabetes?

Answer 37

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

Question 38

what is the advice on recreational drugs for diabetic patients?

Answer 38

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

Question 39

what can cause diabetic patients risks when driving?

Answer 39

Risks of hypos, poor vision, neuropathy

Question 40

what must a diabetic patient do if they plan to drive?

Answer 40

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

Question 41

how long after a hypo are you allowed to drive?

Answer 41

Do not drive for 45 mins after hyp

Question 42

what should diabetic patients do within 2 hours of starting driving?

Answer 42

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.

Question 43

in cars how should patients manage diabetes?

Answer 43

Cars – CGM or flash monitoring of blood glucose

Question 44

what must be monitered in group two vehicles?

Answer 44

Group 2 vehicles – blood glucose

Question 45

how is work / employement affected by diabetes? what exclusions are there?

Answer 45

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

Question 46

how does work affect diabetes?

Answer 46

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

Question 47

what are some hobbies / work to consider carefully before doing with diabetes?

Answer 47

Scuba diving Scaffolder / window cleaner Solo adventures / activities Endurance sports Taxi- driver Emergency vehicle driver Bus / lorry driver Game keeper

Question 48

how should diabetes be controlled with holidays?

Answer 48

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