Ongoing research is happening to understand factors that could influence the destruction of insulin producing cells in type 1 diabetes. However, for type 2 diabetes, we have sufficient knowledge that with behavioural therapy, we can effectively prevent or delay the disease progression.
There is no doubt that a poor lifestyle leads to type 2 diabetes. People have quick and easy access to unhealthy, processed food. Physical inactivity associated with a sedentary lifestyle also contributes to the development of the illness. Strong will and determination is required to be on the road to good health.
Research from the International Diabetes Federation (IDF) from various countries (USA, Finland, China, India andJapan), have shown that by being physically active and/or having a healthy diet, we can achieve the right body weight. Moderate physical activity can help not only in delaying but preventing the onset of type 2 diabetes, including those in the high-risk group1.
Physical activity and weight control
The wide range of benefits from being physically active (the beneficial effect on insulin-sensitivity and glycaemic control, as well as the lipid profile, achieving desired body weight, and positively impacting mood) plays an integral role in the treatment of diabetes. The IDF recommends that you spend a minimum of 30–45 minutes on physical activities three to five times a week2, while the Polish Society of Diabetology recommends daily exercise to achieve the optimal effects3.
The Polish Society of Diabetology (PTD) emphasises that the intensity of physical activities should be tailored: Some suggested activities such as nordic walking (for all ages), taking a quick walk till you are short of breath (patients with type 2 diabetes, aged 65 or more).
For younger patients with no health risk – it is a good idea to focus on high levels of physical activity, including doing sports. However it must be considered that the glycemic effects varies between activites. Aerobic exercises such as nordic walking, cycling or swimming, increases sensitivity to insulin for more than ten hours, while anerobic exercise such as resistance or interval training, triggers the blood glucose immediately after exercising.
However, you need to remember about the glycaemic effect brought on by various types of physical activity – e.g. aerobic exercise (e.g. Nordic Walking, cycling or swimming – after this kind of exertion glucose levels fall, whilst increased sensitivity to insulin will be maintained for a few to more than ten or so hours after finishing), anaerobic exercise (e.g. resistance or interval training, where processes are triggered, which increase blood glucose levels after finishing exercise).
A healthy diet
It is the task of the dietician to prepare a detailed, individualised nutrition plan based on the patient’s needs. There is no one-size-fits-all diet that could be recommended to all patients– the proportions of macronutrients or the calorific count of specific meals should be determined on an individual basis, e.g. based on age, physical activity levels, the presence of any diabetes-related complications, as well as comorbities. The diet should also include complex carbohydrates, which cause the blood glucose level to rise slowly and make you feel full longer, unsaturated omega 3 and 6 fatty acids, which are rich in fat-soluble vitamins A, D, E and K together with complete protein and fibre.
As a rule, the diet of diabetes patient and high risk groups do not differ significantly from a “healthy” diet for the general popuation – it’s important to choose products that are unprocessed. The IDF has prepared a general guidance worth considering when preparing our meals:
- Choose water, coffee or tea instead of fruit juice or sweetened carbonated beverages
- Eat at least three servings of vegetables daily, including green leafy vegetables
- Eat up to three servings of fresh fruit every day
- Choose nuts, fresh fruit, or unsweetened yoghurt for a snack
- Limit alcohol intake
- Choose lean cuts of white meat, poultry or seafood instead of red or processed meat
- Choose peanut butter instead of chocolate spread or jam
- Choose whole-grain bread, rice, or pasta
- Choose unsaturated fats (olive oil, rapeseed oil, corn oil, or sunflower oil) instead of saturated fats (butter, animal fat, coconut oil or palm oil)
- Avoid food and beverages with a high sugar content4
Apart from what we eat, how often and quickly we eat our meals matters. Healthy eating based on five meals a day: three main meals and two snacks, provides your body with regular source of energy. You shouldn’t get to the stage of feeling intense hunger and be tempted to snack on sweets. We should spend about 15 minutes on each meal (which enables the information of our fullness to reach your brain, consuming fewer calories), chewing our food thoroughly (as many as 30 times) to aid in an effective digestion process.
The aim of the above recommendations is to help achieve and maintain a near-normal glucose level, optimal lipid and lipoprotein concentration, optimal blood pressure readings (minimising the risk of vascular disease) and normal body weight.
Healthy sleep and reducing stress levels
The regeneration of the body also plays a vital role in stopping the development of diabetes. Healthy, peaceful sleep impacts on glucose metabolism. Children aged 6–13 requires about 9-11 hours’ sleep, teenagers up to 17 years old – 8–10 hours, adults need 7–9 hours.
Stress is another major factor. We experience stress in our everyday lives. To reduce stress levels, you need to prioritise relaxing every day, depending on your individual preferences. Activities such as physical exercise and uninterrupted sleep, talking to family and friends, a warm bath, drinking herbal tea, taking time out for yourself with a book or your favourite film, calm music or enjoying your hobby can all help to reduce stress.
Education is key
The treatment of diabetes cannot be seen in isolation. Individualized care tailored to each patient need and preference is important. Education on diabetes and implementing changes in your current lifestyle will help in the prevention and development of diabetes complication.
Patients with awareness are able to cope with stress independently, and will be motivated to deal with challenges presented by treatment.
It is important to remember that education in diabetes prevention and treatment is not to be left up to individual patients. Closely working with your multi-disciplinary team of special and allied healthcare workers can help in delaying late stage complication and comorbidities.
It is closely interlinked with having contact with your medical team who will play a key role in dealing with these issues. Collaboration between specialists in related fields is essential, due to the multidisciplinary nature of the late-stage complications of diabetes and comorbities, as is working with the media which can help to communicate the necessary knowledge quickly and easily. It is important to remember that prevention and treatment.
3Source: Polskie Towarzystwo Diabetologiczne [The Polish Society of Diabetology], Diabetologia praktyczna, Zalecenia kliniczne dotyczące postępowania u chorych na diabetes 2019 [Practical diabetology. Clinical recommendations concerning behaviour in patients with diabetes], volume 5, no. 1