Diabetes Management

Lifestyle management including diet control and adequate exercise is essential to the successful treatment of Type II diabetes.

Experts on diet and health and the American Diabetes Association state that there is no single dietary regimen for diabetes. Dietary recommendations may be developed based on the individual’s requirements and treatment goals.

Successful nutritional management of diabetes entails:

  • Regular monitoring of metabolic parameters (including blood glucose, glycated hemoglobin, lipids, and blood pressure)
  • Maintaining healthy body weight
  • Lifestyle management

It is important that diabetics space meals adequately over the day to avoid glucose overload and low blood sugar.

The daily, dietary, caloric breakdown recommended states that 12-20% of the total calories should be supplied by protein, less than 10% of the total calories should be from saturated fats and up to 10% of the calories from polyunsaturated fats and 60-70% of the total calories to be distributed between monounsaturated fats and carbohydrates, based on individual requirements. Complex carbohydrates, such as those from whole grains and vegetables are advocated because they have a lower glycemic index.

The glycemic index represents the sugar value of the food as compared to glucose given a value of 100. All carbohydrates are ultimately converted to glucose in the body. Some nutritionists use white bread as the standard, in which case white bread would have a glycemic index of 100 and glucose would have an index of 142. The lower the glycemic index, the slower the carbohydrate would convert to glucose, thereby avoiding glucose overload.

In view of the increased risk of cardiovascular disease, diabetics should avoid saturated fats (limit to <10% of dietary fat) and limit daily cholesterol intake to < 300 mg.

A diet containing adequate fiber is recommended and is beneficial in maintaining healthy cholesterol levels and gastrointestinal health. Current guidelines advocate a daily intake of 20-35 g per day.

For people with mild to moderate hypertension, 2,400 mg or less per day of sodium is recommended. For people with hypertension and nephropathy, 2,000 mg or less per day of sodium is recommended.

Mild to moderate weight loss (5-10 kg [10-20 pounds]) has been shown to improve diabetes control, even if desirable body weight is not achieved. According to the ADA, weight loss is best attempted by a moderate decrease in calories (250-500 calories less than average daily intake) and an increase in caloric expenditure.

According to ADA sources, exercise programs have not been exclusively shown to improve glycemic control in people with IDDM. However, IDDM individuals would benefit from exercise in terms of cardiovascular health and positive social interaction.

NIDDM patients are recommended to exercise in order to support cardiovascular health, inhibit obesity and augment nutritional measures. The recommendations are that:

  1. Aerobic exercise at 50-70% of an individual's maximum oxygen uptake be included.
  2. The regimen should last 20-45 min and be repeated at least 3 days/wk,
  3. The regimen should include low-intensity warm-up and cool-down exercises
  4. The exercise should be appropriate to the person's general physical condition and lifestyle.
  5. All people with diabetes should be advised to comply with the following guidelines:
  • use proper footwear and, if appropriate, other protective equipment
  • avoid exercise in extreme heat or cold
  • inspect feet daily and after exercise
  • avoid exercise during periods of poor metabolic control.