Lifestyle modification in Prevention and Management of Diabetes

By Consultant Diabetologists Dr. V. Mohan , Dr. Ranjit Unnikrishnan  and Dr. R.M. Anjana

The recent ICMR-INDIAB study which covered four states in India representing the North, South, East and Western regions of our country showed that India has 62 million people with diabetes and 77 million people with pre-diabetes in 2011.  This increased prevalence of diabetes is parallel with the increase in obesity which can be attributed to our sedentary lifestyle.

The importance of promoting a healthy lifestyle for prevention of diabetes and other non-communicable diseases such as cardiovascular diseases and cancer has off late taken centre stage. Lifestyle is the way each one of us approaches the pleasures and pressures of the world. It includes our attitudes, habits, behaviour, physical activity (exercise), diet and stress management. In addition to prevention, the number and doses of drugs used to manage these diseases will tend to increase unless compliance to lifestyle measures is ensured.

Also read: Surgical management of diabetic foot 

Increasing physical activity

One of the strongest drivers of the diabetes epidemic is a marked increase in sedentary lifestyle, especially in urban areas. However, awareness still remains low. In a study done by the Madras Diabetes Research Foundation (MDRF), Chennai it was seen that only 12% of people living in Chennai were aware that decreased physical activity puts people at risk for developing diabetes. Therefore, along with following a healthy meal pattern promotion of physical activity in the community is a key step towards controlling the twin epidemic of diabetes and obesity.

In a 2005 population study done by MDRF in a middle-income neighbourhood in Chennai, it was shown that increasing physical activity through community empowerment can be a good attempt at primary prevention of non-communicable diseases (NCD’s) like diabetes, hypertension, cardiovascular diseases etc. The follow-up research showed that the construction of the park in this colony resulted in a 300% increase in the number of people who exercised in this community. The findings of further studies suggest that this is already having an impact on the prevention of diabetes and obesity in that area.

Also read: Debunking common exercise myths 

Despite the growing evidence of the benefits of exercise, there is still a lack of participation among the general public. The reasons can be many. Starting on an exercise program can take some time and once a person has begun, then adherence to an exercise regime is even more challenging. In case of patients, they either lack the knowledge and awareness about the benefits of exercise, or lack the motivation and sometimes a lack of clear understanding of the recommendations for exercise. This is where doctors can play a crucial role. Specific instructions should be given to patients rather than giving general advice. For e.g.: rather than just saying, “You need to exercise”, a doctor should be saying, “You would benefit very much by a brisk walk for 30 minutes every day”. Such instruction clearly outlines the type and amount of time to be spent on the exercise. We need to encourage simple routine lifestyle changes; tips like using the stairs instead of lifts or parking further from one’s destination and then walking to the destination. However, this should be in addition to a programmed exercise routine which is followed every day.

In addition to the benefits of physical fitness and reduced cardiovascular risk which exercise confers on all patients, regular exercise lowers cholesterol, increases insulin sensitivity and leads to a reduction in insulin requirements. Besides these exercises have important effects on mental health as it releases the “Happy Hormones” – Endorphins, thus having antidepressant effects and reducing anxiety levels. Individuals who exercise regularly report an improved sense of well-being and self esteem.

Also read: Stress & Diabetes 

Eat smart

When you shop, cook or eat out, make healthy choices. Always read labels and select foods that are low in fat, salt, sugars. Avoid processed foods and meats. They will be rich in salt and oil. Use fresh foods. Avoid fried and fatty foods. Choose foods that are boiled, steamed, grilled or baked. When you learn more about good nutrition habits, you will find more choices than you thought. Finally, if you slip up occasionally do not get discouraged just get back to your nutrition plan at your next meal.

Inability to manage our time properly leads to undue stress in our lives. Hence, time and stress management has become an integral component of the lifestyle modification measures. The combination of diet, exercise, and behavioural modification is the most effective approach to a healthier life. Behavioral approaches that teach patients to rearrange their daily schedules, to support healthy eating habits, do a regular physical activity as well as manage their time and stress are important for long-term adherence to lifestyle measures.

Lifestyle and management tips that will help you prevent and control diabetes and thus lead a healthier life!

  1. Make greens part of your daily diet. Include them in cooked vegetables as well as salads.
  2. Consuming a whole fruit (50 kcals) is better than having a fruit juice (150 kcals). Fruits are rich in fiber and make a healthy snack.
  3. Get into the habit of eating ‘little’ but ‘often’. 5-6 ‘small’ meals a day is better than three ‘big’ meals a day.
  4. Maintain a small food diary. Keep track of all the food you eat in a day. You will be amazed at the amount and type of food you eat
  5. Watch what you eat and not the TV while you eat
  6. Exercise 150 minutes per week – 30 mins/day – 5 days a week
  7. Brisk Walking is the most economical exercise.
  8. Take the steps instead of the elevator at every given chance.
  9. Quit tobacco & moderate alcohol consumption.
  10. Prioritize and organize your time and work.
  11. Get 6-8 hours of peaceful sleep every night.
  12. Eat less…. Walk more