Diabetes Mellitus Management : The Non-pharmacological Treatment
Diabetes mellitus is an endocrine disorder in which there is a total or partial deficit of insulin in the human pancreas. As a result, there is a derangement of glucose and fats metabolism in the body. The altered glucose metabolism causes a high blood glucose level resulting in symptoms such as increased thirst, excessive hunger, the passage of a large volume of urine and weight loss.
DiagnosisThe presence of these symptoms above coupled with a fasting blood glucose above 126mgdl confirms a diagnosis of diabetes mellitus.
TreatmentDiabetes can be managed pharmacologically (using drugs such as insulin or oral hypoglycemic) and non-pharmacologically (without drugs). Non-pharmacological treatment involves using exercises, dietary and lifestyle modifications to control blood glucose. This article will focus on the non-pharmacological treatment of diabetes.
Dietary ControlAn ideal diet should have a balanced proportion of macronutrients (carbohydrates, proteins, Fats) and micronutrients (vitamins and minerals). A diabetic diet should be a restricted diet comprising a reduced amount of carbohydrates, low saturated fats and high protein intake with micronutrients which provide the antioxidants required to handle the cellular oxidative stress in diabetes. The blood glucose concentration is determined by the quantity and type of carbohydrates consumed by an individual. Carbohydrate is digested in the intestine to produce glucose which is subsequently absorbed into the bloodstream. The rate at which glucose is absorbed and released into the bloodstream is called glycemic index. Carbohydrates with a high glycemic index lead to a fast release of glucose into the blood from the intestine resulting in high blood glucose rapidly while those with a low glycemic index release glucose gradually into the blood. Therefore, diabetics should avoid carbohydrates with a high glycemic index and should have a diabetic diet containing low glycemic carbohydrates. Examples of high glycemic carbohydrates are processed grains such as white rice, white bread while low glycemic carbohydrates are fiber diets such as spinach, lettuce and green vegetables. Also, insulin sensitivity in the cells is directly related to the quantity of fat deposits in the peripheral tissues like in the muscles and liver. Thus the muscles and liver with excess fat deposits will not optimally absorb glucose from the blood. These fat stores are derived from the consumption of saturated fats diets and these fats are also deposited in large and small blood vessels in the body. This causes diabetics to be susceptible to macrovascular complications such as strokes and microvascular complications such as chronic kidney disease. Hence, it is paramount to restrict not only the type of carbohydrates but also the type of fats consumed. Examples of saturated fats include cheese and butter and these should be avoided. Of note, these deposited fats can also be reduced by regular and proper exercises.
Regular ExercisesExercising daily and consistently have been shown to gradually reduce the blood glucose concentration in diabetics. The benefits of exercises in the body become noticeable after a few days of engaging in appropriate physical exercises. It is recommended to get a professional trainer to direct and coordinate physical exercise sessions so as to optimize the merits of physical activities. Also, the motivation to keep exercising can be enhanced by setting SPECIFIC- MEASURABLE- ACHIEVABLE- REALISTIC- TIME BOUND (S.M.A.R.T) goals.
An example of a SMART goal will be to lose weight by 10 pounds weekly and to reduce blood glucose by 2mgdl daily. As these goals are achieved, the motivation to persistently exercise will be heightened.
Benefits Of ExercisesThe act of exercising constantly has both short-term and long-term benefits. As a result of intense muscular activities during exercises, there is a high demand for glucose and breakdown of deposited fats. Therefore, there is a rapid uptake of insulin which further drives glucose into the tissues where they are utilized. In the short term, there is a gradual decline in the blood glucose and cholesterol levels in the body. Similarly, the long-term effect is a reduced risk of diabetic complications like chronic kidney diseases, hypertension etc.
Types Of Exercises
Aerobic ExercisesPhysical activities like jogging, swimming, biking etc for 30 minutes daily is ideal for keeping the muscles sufficiently active to reduce the blood glucose. It is recommended to start small with these exercises (eg 10 minutes daily) and then slowly increase the duration and intensity of the activities as the body adapts.
Strength Training ExercisesWeight-lifting is an example of this type of exercise which is targeted to tone up the muscles. Start by lifting small weights like dumb-bells across the muscle groups to foster uniform muscular built.
Safety Precautions During Exercise
- Stay hydrated to prevent dehydration which will result in physical exhaustion.
- Wear a diabetic bracelet indicating whether you are on insulin or not. This helps during an emergency intervention.
- Wear comfortable shoes to prevent feet injuries.
- Have a glucose snack or fluid close by in case of exercise-induced hypoglycemia.
Lifestyle EffectsA person’s way of life negatively impacts the blood glucose control with time. Avoid habits such as sedentary lifestyle, smoking cigarettes, excessive alcohol consumption, and psychological stress.
Lifestyle Effects On Blood GlucoseProlonged exposure to stress increases the level of corticosteroids in the body which promote the release of glucose into the blood from the glycogen stores. Furthermore, sedentary lifestyle and consuming psychoactive substances increases the deposition of fats in the muscles and liver together with marked insulin resistance.
- Avoid sedentary lifestyle by engaging in little physical activities like walking for 10-15 minutes daily.
- Reduce the consumption of alcohol and stop the intake of psychoactive substances.
- Identify and manage stressful events such as family and work stress.