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
hodoes exercise affect diabetes?
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)
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
Address diabetes specific barriers:
- Fear of hypos/insulin adjustment/lack of knowledge/nutrition
Provide facilities/Social/work place structure
Community involvement/Schools etc
Councils/Government strategies
how does diabetes affect driving?
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
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
how does insulin treated diabetes affect work/employment?
Disability Discrimination Act 2010
Some absolute exclusions: Armed forces/police
Up to employer/individual: offshore oil limited but increasing, Blue light rapid response drivers
Driving restrictions
What are some hobbies/work to consider carefully before doing?
Scuba diving
Scaffolder/window cleaner
Solo yachtsman/women
(Endurance sports)
Taxi-driver
Emergency vehicle driver
Bus/lorry driver
What is there to think about with holidays in regards to diabetes?
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
