Diabetes: Type 2

Description

Alternative Names

Lifestyle Changes

A simple heart-healthy diet with weight control may be sufficient for people with type 2 diabetes. In fact, a 2002 study reported that successful lifestyle changes were more effective than metformin -- a major drug used in type 2 diabetes -- in preventing type 2 diabetes in high-risk individuals. On the other hand, the so-called Western diet (higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts) poses a high risk for type 2 diabetes. Lifestyle changes are difficult to initiate and sustain, however. Patients should be certain to surround themselves with a solid network of doctors, dietitians, family, and friends who understand both their condition and their needs.

Heart-Healthy Diet

Currently, there is much controversy over the best balance of carbohydrates, fats, and protein. A number of dietary approaches for improving the heart are available:

• Therapeutic Lifestyle Changes (TLC) from the National Cholesterol Education Program.
• The Mediterranean Diet.
• Very low-fat diets, particularly the Ornish Program.
• The Dietary Approaches to Stop Hypertension (DASH) diet. This diet has been designed specifically to help people reduce blood pressure.
• Restricted calorie diets.

Although all the major dietary approaches differ in important aspects, they have some recommendations in common:

• Choose fiber-rich food (whole grains, legumes).
• Choose fresh fruits and vegetables.
• Choose unsaturated fats (found in vegetable and fish oils) over saturated fats (found mostly in animal products) and trans-fatty acids (found in hydrogenated fats and many commercial products and fast-foods).
• In selecting proteins, choose soy protein, poultry, and fish over meat.
• Weight control and exercise are essential companions of any diet program.
• After embarking on any heart-healthy diet, it generally takes an average of three to six months before any noticeable reduction in cholesterol occurs, although some people have reported better levels in as few as four weeks.

[For detailed information, see Well-Connected Report #43 Heart-Healthy Diet]

Weight Loss

The Diabetic Diet. The current state of the diabetic diet is in flux, and at this time, there is no single diet that meets all the needs of everyone with diabetes. Patients should meet with a professional dietitian to plan an individualized diet that takes into consideration all health needs. There are some constants, however:

• Limit fats (particularly saturated fats and trans-fatty acids).
• Limit dietary cholesterol.
• Consume plenty of fiber-rich foods in the form of whole grains and fresh fruits and vegetables.
• Limit protein.
• Reduce salt.

[For detailed information, see Well-Connected Report #42 Diabetes Diet]

Weight Loss with Diet and Medications. Being overweight is the number one risk factor for type 2 diabetes. Even modest weight loss can help prevent type 2 diabetes from developing. It can also help control or even stop progression of type 2 diabetes in people with the condition. Unfortunately, not only is weight loss difficult to sustain, but many of the oral medications used in type 2 diabetes cause weight gain as a side effect. For obese patients who cannot control weight using dietary measures alone, weight-loss drugs, such as orlistat (Xenical) or sibutramine (Meridia), may be beneficial. Orlistat may have specific benefits for people with diabetes. It may not only achieve weight but also improved glucose, cholesterol, and lipid levels. Surgical procedures are proving to be extremely beneficial in selected cases. [For detailed information, see Well-Connected Report #53, Obesity.]

Exercise

Sedentary habits, especially watching television, are associated with significantly higher risks for obesity and type 2- diabetes. Regular exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity and may play a significant role in preventing type 2 diabetes--regardless of weight loss. An important study reported a 58% lower risk for type 2 diabetes in adults who performed moderate exercise for as little as 2.5 hours a week.

In 2002, a well-conducted study on overweight adults confirmed previous research that reported beneficial changes in cholesterol and lipid levels, including lower LDL levels (the so-called bad cholesterol), even when people performed low amounts of moderate or high intensity exercise (e.g., walking or jogging 12 miles a week). However, more intense exercise is required to significantly change cholesterol levels, notably increasing HDL (the so-called good cholesterol). An example of such a program would be jogging about 20 miles a week. Such benefits in the study occurred even with very modest weight loss, suggesting that overweight people who have trouble losing pounds can still achieve considerable heart benefits by exercising.

Aerobic Exercises. Aerobic exercise is proving to have significant and particular benefits for people with both type 1 and type 2 diabetes. Regular aerobic exercise, even of moderate intensity, improves insulin sensitivity. People with diabetes are at particular risk for heart disease, so the heart protective effects of aerobic exercise are very important for this patient population. Moderate exercise, in fact, protects the heart in people with type 2 diabetes, even if they have no risk factors for heart disease other than diabetes itself. (In general, when exercising people with diabetes, should aim for a heart rate target of 55% to 75% of their maximum heart rate.)

Strength Training. Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes, but evidence is needed to confirm this.

Yoga. One study reported that yoga helped patients with type 2 diabetes reduce their need for oral medications.Studies have indicated that yoga and Tai Chi (an ancient Chinese exercise involving slow relaxing movements) may lower blood pressure almost as well as moderate-intensity aerobic exercises.

Some Precautions for People with Diabetes Who Exercise. The following are precautions for all people with diabetes, whether type 1 or 2:

• Because people with diabetes are at higher than average risk for heart disease, they should always check with their physicians before undertaking vigorous exercise. For the best and fastest results, frequent high-intensity (not high-impact) exercises are best for people who are cleared by their physicians. For people who have been sedentary or have other medical problems, lower-intensity exercises are recommended using regimens designed with physicians.
• Strenuous strength training or high-impact exercise is not recommended for people with uncontrolled diabetes. Such exercises can strain weakened blood vessels in the eyes of patients with retinopathy. High-impact exercise may also injure blood vessels in the feet.

Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program.

• Glucose levels swing dramatically during exercise; people with diabetes should monitor their levels carefully before, during, and after workouts.
• Patients should probably avoid exercise if glucose levels are above 300 mg/dl or under 100 mg/dl.
• To avoid hypoglycemia, diabetics should inject insulin in sites away from the muscles they use the most during exercise.
• They should also drink plenty of fluids. Before exercising, they should also avoid alcohol, which increases the risk of hypoglycemia.
• Insulin-dependent athletes may need to decrease insulin doses or take in more carbohydrates prior to exercise but may need to take an extra dose of insulin after exercise. Stress hormones released during exercise may increase blood glucose levels; in non-diabetics insulin is released to control this. The diabetic therefore needs to test their blood sugar and take an extra dose as instructed by their diabetes healthcare provider.
• Anyone with existing hypertension should discuss an exercise program with their physician. Before starting to exercise, people with moderate to severe hypertension should lower their pressure and be able to control it with medications. They should avoid caffeinated beverages, which increase heart rate, the workload of the heart, and blood pressure during physical activity. Everyone, and especially people with high blood pressure, should breath as normally as possible through each exercise. Holding the breath increases blood pressure.
• Good, protective footwear is essential to help avoid injuries and wounds in the feet.

Monitoring Glucose (Blood Sugar) and Hemoglobin A1C

In 2002, the American Heart Association revised its guidelines for preventing heart disease and recommended that people with diabetes should aim for fasting blood glucose levels of less than 110 mg/dl and hemoglobin A1C or less than 7%.

Measuring Blood Glucose. In patients being treated with insulin or insulin-producing or sensitizing drugs, it is important to monitor blood glucose levels carefully to avoid hypoglycemia. Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.

Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. For patients who have become insulin-dependent, more intensive monitoring is necessary. Usually, a drop of blood obtained by pricking the finger is applied to a chemically treated strip. The glucose level is read on a standard meter or a small, portable digital display device.

Measuring Hemoglobin A1C. Hemoglobin A1c (HbA1c), or glycated hemoglobin, is measured periodically to determine the average blood-sugar level over the life span of the red blood cell, which is about eight to 10 weeks. Home tests (DRx, Metrika A1c Now) are available for measuring HbA1c that may allow even better monitoring of glucose levels.

To monitor the amount of glucose within the blood a person with diabetes should test their blood regularly. The procedure is quite simple and can often be done at home.

Improving Sleep

Some research suggests that not getting enough sleep may impair insulin use and increase the risk for obesity. More research is needed, but it is always wise to improve sleep habits.