Diabetes is a disease that can strike at any time in one’s life. Diabetes affects approximately 300 million people worldwide and 23.6 million people in the United States, according to current research and clinical data. Patients, family members, and/or caregivers must understand the disease state of diabetes and how it affects one’s overall health, just as they would with any other health condition. The role of lifestyle behaviors in the causes, prevention, and management of type 2 diabetes is discussed in this article.
Obesity and Diabetes
As the prevalence of obesity rises, so does the prevalence of type 2 diabetes. As many as 90% of people with type 2 diabetes are overweight or obese. The trends for each disorder are startlingly similar. Obese people with type 2 diabetes are at a significantly higher risk of poor health outcomes related to hypertension, cardiovascular disease, dyslipidemia, nephropathy, and visual disturbances such as glaucoma and blindness. Obesity and diabetes complications also contribute to shortened life expectancies.
Furthermore, some populations in the United States face greater health disparities as a result of their overweight/obese status. African American women, certain Native American subgroups (Zuni, Pima), and Hispanics of all ages are at increased risk.
PROMOTING HEALTH IN THE USA
The United States government issued its report, Healthy People 2010, outlining the nation’s disease prevention and health promotion agenda. This document included 26 focus areas and objectives for specific populations related to lowering type 2 diabetes, lowering cardiovascular disease deaths (in diabetics), and increasing healthful nutrition, physical activity/fitness, and access to quality health services.
One of the primary goals of Healthy People 2010 was to improve the health, fitness, and quality of life of all Americans by encouraging them to engage in regular physical activity. This was a brand-new feature of the survey’s tracking systems. However, it is clear that the American population did not meet these public health goals for diabetes and obesity by 2010, and that meeting them in the future will be difficult. This could be due to the complexity of the factors influencing health status, as well as the fact that health promotion and disease prevention have never received the same research funding or attention as disease/illness management.
Type 2 diabetes is thought to be preventable through weight loss and active lifestyle interventions such as exercise and eating a well-balanced diet. At least four clinical trials have looked at the impact of lifestyle factors like diet, exercise, and medications, either alone or in combination, on the prevention of type 2 diabetes. These studies show that changing one’s lifestyle can reduce diabetes by 42% to 63%.
Prediabetes, Diabetes & Obesity
Obesity and type 2 diabetes are common conditions in Western societies, where high-calorie food consumption and sedentary lifestyles are the norm. This combination of conditions is commonly referred to as “diabesity.” Some experts believe that the historical transition from an agricultural/hunter-gatherer system to one of urbanization and industrialization has resulted in the problem of “diabesity.”
The definitions that follow will facilitate understanding of what each disease is and how it is diagnosed.
Type 2 diabetes is frequently preceded by prediabetes, which is defined as an elevated blood glucose level that is higher than normal but not high enough to warrant a diabetes diagnosis. According to the Centers for Disease Control and Prevention, 57 million people in the United States are suspected of having prediabetes. This suggests that these individuals are at risk of developing type 2 diabetes unless they make a concerted effort to improve their health status.
Prior to the coinage of the term prediabetes, undiagnosed diabetes with elevated blood glucose levels but not meeting the diagnostic criteria for full-blown diabetes was referred to as impaired glucose tolerance or impaired fasting glucose. Obesity and acanthos nigricans, demarcation often seen on the neck or other skin folds on the body, are other clinical indications of prediabetes.
Diabetes is identified through a diagnostic process. To confirm a diabetes diagnosis, the following factors must be present on initial and subsequent laboratory testing: (a) fasting blood glucose of 126 mg/dL or higher, (b) random plasma glucose of 200 mg/dL or higher with classic diabetes symptoms, or (c) an oral glucose tolerance value of 200 mg/dL or higher in the 2-hour sample reading. Type 2 diabetes is distinguished from all other types of diabetes by either a lack of ketone bodies excreted in urine or the presence of obesity.
Obesity is defined as having too much adipose tissue or, in many cases, visceral fat. It is defined as excess body fat that is 20% or more above ideal body weight, or, in more general terms, a BMI greater than or equal to 30. Overweight is defined as having a BMI between 25 and 29.9. Morbid obesity is defined as a BMI greater than 35.
The following formula is used to calculate BMI: weight in kilograms divided by height in meters squared. There are several methods for determining the degree of obesity. However, BMI is the most widely used for classification purposes because it is easily calculated by all clinicians using simple arithmetic equations or readily available tables.
Obesity is associated with a variety of health risks, including, but not limited to, type 2 diabetes, hypertension, lipid abnormalities, menstrual irregularities, and digestive issues such as gallstones and fatty liver. Furthermore, respiratory diseases such as Pickwickian syndrome and sleep apnea are common in morbidly obese people.
Good nutrition is important to everyone, especially persons with diabetes. Individuals who need to effectively manage diabetes, control blood glucose levels, and have a more healthful and energetic life will need to control what they eat, when they eat, and how much they eat and to understand why they are eating. Choosing the correct balance of foods for an individual meal plan can be one of the most challenging aspects of diabetes care.
According to research, when an individual gains more than 30% of their ideal body weight, tissue sensitivity to insulin action decreases to around 40%. The cause of type 2 diabetes’s lack of tissue sensitivity appears to be an increase in the circulating level of free fatty acids. These acids inhibit several enzymatic steps in the glycolytic cascade, making muscles and liver less receptive to insulin’s effects. High levels of free fatty acids worsen insulin resistance, resulting in glucose toxicity. Extremely high levels of glucose in the blood cause pancreatic beta cells to overcompensate by producing more insulin. This is referred to as hyperinsulinemia.
There are no signs or symptoms of hyperinsulinemia. For a while, the affected individuals will have normal fasting capillary glucose values. Initially, this was referred to as prediabetes. This extreme metabolic situation disables the pancreas’s beta cells, eventually leading to full-blown diabetes. Diabetes is clearly caused by a complex and sequential series of metabolic and cellular events. However, diet, sedentary lifestyle, age, and genetic influences all play a role in the development of this disorder.
Planning Healthy Meals
The goal of planning healthful meals with more variety and nutritional value is to improve insulin sensitivity, stabilize blood glucose levels, achieve healthy levels of blood fats (lipids), and achieve a healthy body weight. A healthy diet is one that is low in fat, low in sodium, high in fiber, and allows for a moderate carbohydrate intake in general. There is no single food that can provide all of the nutrients required by the body.
One of the most effective strategies for promoting weight loss is to reduce portion sizes, increase intake of vegetables and whole grains, limit fat and sugar, reduce or eliminate highly caloric beverages, and reduce or change the content of between-meal snacks. It is critical to understand that everyone needs to eat a variety of foods every day for energy, growth, cellular repair, and overall health. It’s also worth noting that food has a social and cultural component that will undoubtedly influence its role in the management and prevention of type 2 diabetes and obesity.
BUILDING BLOCKS OF NUTRITION
There are 6 building blocks in nutrition:
- carbohydrates(starch and sugar)
- proteins (meat, fish,eggs, and nuts)
- fat (butter, oils)
- vitamins (A, B complex, C, D, E, niacin, and riboflavin)
- minerals (calcium, magnesium, phosphorus, zinc, and chromium)
The first three elements provide the energy that the body requires to grow and perform, and they require insulin for proper metabolism; thus, these elements can and will cause blood glucose levels to rise. The second three building blocks are required for normal maintenance but do not provide energy to our bodies, so they do not require insulin for metabolism. There is currently no evidence that people with diabetes require additional vitamins or minerals unless a deficiency is discovered through laboratory testing.
According to the American Dietetic Association, an individualized caloric meal plan for diabetics should be based on glucose levels, lipid values, weight, and activity levels. The recommended calorie percentage for diabetics should fall within this framework: Carbohydrates should make up approximately 40% to 50% of the meal plan, proteins should make up approximately 20% to 30% of the meal plan, and fats should make up approximately 20% to 30% of the meal plan. Fiber consumption should ideally range between 20 and 35 g per day.
Exercise and Physical Activity
Exercise is a well-established treatment foundation for obesity and diabetes. The goal of exercise is to increase energy expenditure in order to reduce adipose tissue in an individual. Exercise has also been shown to help with blood glucose control. All diabetics should be able to engage in some form of physical activity. The benefits of leading a healthy, physically active lifestyle far outweigh the risks. Regular exercise raises HDL cholesterol, caloric expenditure, lean body mass, respiratory capacity, musculature, endurance, and strength. Exercise also improves bone health and increases endorphins, which improve mood.
Many health- and hospital-based medical wellness centers provide their clients with both resistance (strength) and aerobic activities. Both resistance and aerobic training are beneficial to one’s health. It should be noted that only strength training has been shown to reduce the likelihood of bone fractures and increase bone density. Muscles, tendons, ligaments, and bones need to be stimulated on a regular basis to stay in shape. Being in shape conveys the impression of someone who is in good health, has good muscular tone, and has a zest for life’s adventures.
TYPES OF EXERCISE
There are several types of exercise one can perform for optimal glucose control, weight loss, general health, and risk reduction of many comorbidities.
Aerobic exercise: Walking, running, bicycling, swimming, and participation in sports such as basketball, tennis, and soccer strengthen the heart and lungs and tone the muscles.
Muscle strength exercise (resistance training): Resistance training consists of using free weights, machines, or one’s own body weight to strengthen and build those muscles not isolated in an aerobic or other type of exercise routine.
Balancing exercises: These focus on the development and use of core-strength strategies that would be of particular benefit with any of the previous exercise categories.
Many scientific and health organizations recommend that 45 to 60 minutes of exercise of moderate intensity be performed for a minimum of 3 d/wk and more often (4–5 d/wk) for increased weight loss(maintenance of BMI <25), cardiovascular benefit, and further risk reduction.
EVALUATING PHYSICAL ACTIVITY
To determine if there are any contraindications to specific exercise routines and to assist individuals and their health care providers in designing an appropriate individual activity plan, a complete history and physical examination, including laboratory workup, should be performed. Individuals who are just starting an activity program should also understand that they will not and should not notice a noticeable change in fitness, weight loss, or musculature during the first few weeks of an exercise program. It is also critical to recognize that exercise is a lifestyle choice that promotes overall health, wellness, weight loss, and metabolic control while also providing a sense of physical well-being.
Creating an exercise prescription is a combination of art and science. That is, the prescription for an individual must be written in a systematic manner, with specific recommendations for exercise mode (the type of exercise to be chosen), frequency, intensity, and duration. When designing an exercise program for people with diabetes who are overweight or obese, special precautions should be taken. The following safety precautions should be taken:
- When and why to take medications in relation to exercise
- How often to check blood sugar in relation to exercise
- When and what to eat in relation to exercise
- Plans for hydration before, during, and after exercise
- Use of emergency medical identification
- Proper clothing and foot care
- Exercises to avoid (based on medical condition or presence of complications)
Working with your healthcare provider to maintain a healthy lifestyle approach to your diabetes will be critical. They will assist you in determining which habits will have the greatest impact on your health goals. If you start to feel uneasy or lack motivation, reach out to a support system of family, friends, and others.
Diabetes management and weight control do not occur overnight. It is the result of the patient’s time, practice, innovation, and energy, as well as the support system and diabetes health team.