Four major influences in diabetes management are:
• Nutrition and optimal dietary habits
• Fitness and exercise
• Lifestyle choices and coping with stress
• The correct insulin dosage
Nutrition and Optimal Dietary Habits
Food (mainly carbohydrates) is one of the major influences on blood sugar levels in people with diabetes. Recommendations for the use of added sugars for people with diabetes have changed. They have gone from avoidance of sugars to allowing a small amount of sugar within the context of a healthy meal plan. The right amounts and types of food are essential, and diets should be designed on an individual basis by medical professionals. People with Type 2 diabetes can sometimes be treated with diet and exercise alone, however people with Type 1 diabetes must also have insulin injections along with a diet and exercise plan.
Objectives of Food Management
No matter which of the food plans are used, the objectives of diet plans are the same:
• To balance insulin and carbohydrate intake in order to keep the blood glucose values as close to normal as possible
• To maintain a normal weight
• To keep the blood fats (cholesterol and triglycerides) and lipoproteins (LDL and HDL) at desired levels
• To help prevent high blood pressure
• To improve overall health by maintaining the best possible nutrition
• To help avoid long-term diabetes complications
• To help attain normal growth and development for children
• To help prevent severe hypoglycemia
Since eating carbohydrates increases blood sugar levels, one diet approach is to count the intake of carbohydrates and then administer the appropriate amount of insulin. It is used with both multiple daily insulin injections or with insulin pump therapy. For this approach to be effective, the patient must learn to read food labels and accurately assess the number of grams of carbohydrates they are eating. The correct dose of insulin per number of grams of carbohydrates (insulin-to-carbohydrate ratio) is determined by the physician and dietitian. This ratio is then used to determine the insulin dosage to account for the carbohydrates eaten. Many patients like this method because it allows for greater freedom and flexibility in food choices.
Fitness and Exercise
Many people who best control diabetes are those who are fit and who exercise regularly. Exercise should be a regular part of life for everyone. Standard guidelines for Americans are 60 minutes of moderate to rigorous physical activity per day to prevent weight gain and a minimum of 30 minutes a day to reduce the risk of chronic disease (e.g., Type 2 diabetes). The American Academy of Pediatrics also recommends a minimum of 60 minutes of exercise daily for all children and adolescents. Reasons why exercise is important for people with diabetes are listed below. We strongly encourage regular exercise for anyone who has diabetes.
• Exercise lowers blood sugar levels
• Exercise helps people feel better
• Exercise helps maintain proper body weight
• Exercise helps keep the heart rate (pulse) and blood pressure lower
• Exercise helps keep blood fat levels normal
• Exercise improves insulin sensitivity
• Exercise may help maintain normal blood circulation in the feet
Preventing low blood sugar with exercise is important. Frequent blood sugar checking before, during and after exercise helps to prevent the lows. Insulin doses may need to be reduced to bring levels back into balance. Insulin pumps allow reduction or stopping of insulin during the exercise. Many people use snacks prior to exercise if excess body weight is not an issue. Proper hydration is essential during the exercise.
Diabetes affects the entire family. Research has shown that children, adolescents and even adults do best when there is strong family support and involvement. Immediately after diagnosis there can be a lot of different emotions and frustrations. These typically improve over time, but can resurface throughout an individual’s life. Sometimes these feelings persist and affect one’s life and diabetes care.
It is important for families to share diabetes responsibilities. Adults do the best when they work together and support one another. We encourage both parents to share the responsibility for the diabetes care of their child, including blood sugar checks, carbohydrate counting and insulin injections. Both parents should try to attend clinic visits. Single-parent families may wish to bring a support person.
For children, leading a normal life means participating in age-appropriate activities with their family and peers. Diabetes can make fun things like sleepovers and birthday parties a little more stressful, but with some flexibility and creativity, children with diabetes are able to participate in these activities just like their siblings and friends.
Most people will have high blood sugar levels following competitive activities and stress, although some children can have low blood sugar levels due to extra activity. It is important to plan ahead and reduce the insulin dose or give extra food as needed. It is also important to monitor blood sugar levels more frequently to prevent low blood sugar on days with increased activity or stress.
Lifestyle: Teens and Adults
Special challenges occur during the teenage years, when diabetes is often not a high priority. Consistency in areas that would benefit diabetes control sometimes needs to be compromised in helping a teenager to develop normally. Parents must find ways to stay involved in the diabetes management without being overbearing. They must be available to help and to be supportive, but still let the teenager gain independence.
Adults who have diabetes may go to social events, organize conferences and arrange potlucks. Group activities provide a way for people with diabetes to connect socially as well as express frustrations or exchange health tips. Sometimes people might prefer to not talk about diabetes at all. Ask a diabetes health care provider or look online for groups that meet in your area.
Diabetes communities commonly come together to exercise as a group. Groups have formed that cater to people with diabetes to teach them the best ways to exercise effectively and safely. These groups teach the tricks that help eliminate exercise-induced low blood sugar (hypoglycemia). Joining a group that meets regularly for walking, bike rides or runs will provide more motivation to exercise.